Effect of cotrimoxazole prophylaxis on the infectious morbidity not related to malaria among West Africans HIV-infected Adults

Abstract

The aim of our study was to describe the infectious morbidity not related to malaria in MALHIV, a cohort of patients living with HIV, exposed or not to cotrimoxazole prophylaxis. This was a prospective, longitudinal, multicenter; comparative, descriptive study nested within the MALIHV, conducted in four Infectious Diseases Unit (Abidjan, Bamako, Dakar, Bobo-Dioulasso), among HIV-1 infected patients followed for at least 12 months. The primary endpoint was the global incidence of infectious morbidity not related to malaria during follow-up after the inclusion of patients in the study. Our study included 527 patients with an average age of 37 years, a sex ratio of 0.44, divided into 2 groups: one group exposed to cotrimoxazole, group CTX EB (64.5%) and a non-exposed, group CTX 0 (35.5%). At baseline the average CD4 count was 287.9 cells / mm3 and the mean viral load was 5.8 log 10. A total of 391 (67%) patients received antiretroviral therapy. The global incidence of infectious events not related to malaria was 54.6% with an incidence density rate estimated to 36.4/100 person-years (PY). The incidence density rate of severe morbidity was 12.6/100 PY, mainly represented by tuberculosis. Bacterial diseases were more frequently observed in the 2 groups. The incidence density rate in the group CTX 0 was 26.6/100 PY vs 11.6/100 PY in the group CTX EB with a statistically significant difference (p < 0.05). Non-AIDS events were predominantly found in the group CTX 0 with an global incidence of 2 1.6% vs 7.6% in the exposed group, led to a reduction rate of 60% (P < 0.05). Our study confirms the protective effect of CTX chemoprophylaxis on infectious morbidity not related to malaria and highlights the interest of the new WHO Guidelines suggesting to prescribe cotrimoxazole prophylaxis to the patient living with HIV regardless of the CD4 count particularly in settings with a high prevalence of bacterial diseases and malaria.