Journal Article

Effect of cotrimoxazole on mortality in HIV-infected adults on antiretroviral therapy: a systematic review and meta-analysis

Suthar, Amitabh B, Van Rie, Annelies, Granich, Reuben, Mermin, Jonathan

2012

Overview

To determine whether cotrimoxazole reduces mortality in adults receiving antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection in low- and middle-income countries through a systematic review and meta-analysis. PubMed and Embase were searched for randomized controlled trials and prospective and retrospective cohort studies that compared mortality or morbidity in HIV-infected individuals aged ≥ 13 years on cotrimoxazole and ART and on ART alone. The Newcastle-Ottawa Quality Assessment Scale was used to assess selection, confounding and measurement bias. Publication bias was assessed using Egger's and Begg's tests. Sensitivity analysis was performed because the I-squared statistic indicated substantial heterogeneity in study results. A random-effects model was used for meta-analysis. Nine studies were included. Begg and Egger P-values for the seven that reported the effect of cotrimoxazole on mortality were 0.29 and 0.49, respectively, suggesting no publication bias. The I-squared statistic was 93.2%, indicating high heterogeneity in study results. The sensitivity analysis showed that neither the follow-up duration nor the percentage of individuals with World Health Organization stage 3 or 4 HIV disease at baseline explained the heterogeneity. The summary estimate of the effect of cotrimoxazole on the incidence rate of death was 0.42 (95% confidence interval: 0.29-0.61). Since most studies followed participants for less than 1 year, it was not possible to determine whether cotrimoxazole can be stopped safely after ART-induced immune reconstitution. Cotrimoxazole significantly increased survival in HIV-infected adults on ART. Further research is needed to determine the optimum duration of cotrimoxazole treatment in these patients.

• Publisher: Organisation mondiale de la santé,World Health Organization,The World Health Organization
• Subject: Adults / Analysis / Anti-HIV Agents - therapeutic use / Anti-Infective Agents - therapeutic use / Anti-Retroviral Agents - therapeutic use / Antiretroviral agents / Antiretroviral drugs / Antiretroviral therapy / Bias / Biological and medical sciences / CD4 Lymphocyte Count / Chronic illnesses / Clinical trials / Cohort analysis / Confidence Intervals / Cotrimoxazole / Developing countries / Drug therapy / Encephalitis / Epidemiology / General aspects / Global Health / Gram-positive bacteria / Health / Heterogeneity / High income / HIV / HIV Infections - drug therapy / HIV Infections - mortality / Human immunodeficiency virus / Humans / Immune system / Industrialized nations / Kaposis sarcoma / LDCs / Low income groups / Malaria / Measurement / Medical research / Medical sciences / Medical treatment / Meta-analysis / Miscellaneous / Morbidity / Mortality / Mortality - trends / Mortality rates / Odds Ratio / Organizations / Patients / Pneumonia / Prescription drugs / Protozoa / Public health / Public health. Hygiene / Public health. Hygiene-occupational medicine / Quality assessment / Receiving / Sarcoma / Sensitivity analysis / Sepsis / Statistics as Topic / Streptococcus infections / Systematic review / Systematic Reviews / Therapy / Time Factors / Treatment Outcome / Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use