Effects of cotrimoxazole prophylaxis on Talaromyces marneffei infection in HIV/AIDS patients receiving antiretroviral therapy: a retrospective cohort study

Abstract

The dimorphic fungus Talaromyces marneffei (TM) is a common cause of HIV-associated opportunistic infections in Southeast Asia. Cotrimoxazole (CTX) inhibits folic acid synthesis which is important for the survival of many bacteria, protozoa, and fungi and has been used to prevent several opportunistic infections among HIV/AIDS patients. We question whether CTX is effective in preventing TM infection. To investigate this question, we conducted an 11-year (2005–2016) retrospective observational cohort study of all patients on the Chinese national antiretroviral therapy (ART) programme in Guangxi, a province with high HIV and TM burden in China. Survival analysis was conducted to investigate TM cumulative incidence, and Cox regression and propensity score matching (PSM) were used to evaluate the effect of CTX on TM incidence. Of the 3359 eligible individuals contributing 10,504.66 person-years of follow-up, 81.81% received CTX within 6 months after ART initiation, and 4.73% developed TM infection, contributing 15.14/1,000 person-year TM incidence rate. CTX patients had a significantly lower incidence of TM infection than non-CTX patients (4.11% vs. 7.53%; adjusted hazard ratio (aHR) = 0.50, 95% CI 0.35–0.73). CTX reduced TM incidence in all CD4 + cell subgroups (<50 cells/μL, 50–99 cells/μL, 100–199 cells/μL), with the highest reduction observed in patients with a baseline CD4 + cell count <50 cells/μL in both Cox regression and the PSM analyses. In conclusion, in addition to preventing other HIV-associated opportunistic infections, CTX prophylaxis has the potential to prevent TM infection in HIV/AIDS patients receiving ART.

Magnitude and predictor factors of opportunistic infections among adult treatment users at universty of Gondar, 2019

“…Higher than the study done in Ethiopia in all types of health facility [4]. Might be due to the presence of invasive diagnostic modalities in specialized referral hospital [13] But less than the study done in south Tigray region, Addis Abeba and Sidama [10,14,15] Might be due to patients coming late to health care service with opportunistic infection before anti-retroviral treatment initiation [16,17].Provisions of cotrimoxazole prophylaxis to the eligible anti-retro viral treatment initiated patients indicated protective to the opportunistic infections than the patients who have no cotrimoxazole prophylaxis was in line with [2,[18][19][20][21]. Might be associated with the treatment of diseases indicating the WHO clinical stage of ART administration and the continuation of prophylaxis as the national ART guideline recommendation reduce opportunistic infections [20] Patients who have base line CLINICAL stage 3 and stage 4 developed opportunistic infections than patients who have BASELINE clinical stage 1and stage 2 condition was in line with the study [14,18,[22][23][24][25] This might be due to low CD4 count to protect the disease, different studies indicated patients who have lowCD4 count vulnerable to opportunistic infections[26-29] Immediate diagnosis and treatment of the opportunistic diseases at the initiation of anti-retro viral treatment, intensive screening eligible patients for supportive treatment and anti-retro viral treatment drug adverse effect is reduce the occurrence of opportunistic diseases [18,30,31].…”

Impact of low-level viremia with drug resistance on CD4 cell counts among people living with HIV on antiretroviral treatment in China

“…To date, the implications and clinical significance of LLV with drug resistance are still not clear in China. Additionally, few or no studies have analyzed the possible role of LLV with drug resistance as a tool to predict CD4 cell count < 200 cells/ μL , while patients who initiate ART with a CD4 > 200 cells/ μL are at reduced risk of death and serious opportunistic infections [ 28 – 32 ]. Whether VF thresholds should be lowered in patients from NFATP is yet to be determined.…”

Comparative qualitative and quantitative assessment of selected brands of Co-trimoxazole tablets and suspensions procured from Lagos State, Nigeria using first derivative UV spectroscopy and HPLC

“…A fixed dose combination of sulphamethoxazole and trimethoprim was introduced in the 20 th century to treat a broad spectrum of bacterial infections, including urinary tract infections, gram-negative sepsis, respiratory infections, enteric infections, sexually transmitted infections, and opportunistic infections common with HIV positive individuals [9][10]. The drug formulation could promote synergism between the two antibiotics, thereby improving the therapeutic outcomes of patients with bacterial infections [11].…”