Several studies have shown that daily use of the antibiotic cotrimoxazole reduces morbidity and mortality among people living with HIV (PLHIV) in sub-Saharan Africa. Based on these studies and the recommendation of the World Health Organization, the Malawi Ministry of Health includes cotrimoxazole as part of a standard package of preventative services for all PLHIV. The medication helps to prevent opportunistic infections and, in some circumstances, malaria among adults and children.
There is evidence, however, from resource-rich settings that it is safe to discontinue cotrimoxazole in patients when their immune systems have at least partially recovered due to antiretroviral treatment. Uncertainty remains if continued cotrimoxazole under such circumstances is beneficial for patients in sub-Saharan Africa and if there is benefit, whether this would be due to preventing bacterial infections, malaria or both.
With approximately 1 billion doses of cotrimoxazole prescribed per year across Africa, the effectiveness of this medication needs to be definitively evaluated in adults who are on successful ART as these doses could be potentially removed from the HIV care regimen and the resources reallocated. Alternatively, if found to be beneficial, cotrimoxazole could be more broadly reinforced as a method to save lives and prolong the effectiveness of ART.
To determine if the preventative use of the antibiotic cotrimoxazole or the antimalarial chloroquine is associated with reduced morbidity and mortality among adults receiving successful ART and if any benefits are due to the medication’s antimalarial properties.