The Anti-inflammatory Effects of Cotrimoxazole Prophylaxis for People Living With Human Immunodeficiency Virus in Sub-Saharan Africa.

Cotrimoxazole prophylaxis reduces morbidity and mortality among people living with human immunodeficiency virus (HIV) in sub-Saharan Africa, regardless of age, degree of immunosuppression, disease stage, or duration of antiretroviral therapy (ART) [1–6]. Long-term cotrimoxazole is therefore included in World Health Organization (WHO) recommendations for people with HIV in areas with a high prevalence of severe bacterial infections and/or malaria [7]. It is surprising that cotrimoxazole confers such clinical benefits, given the high prevalence of antimicrobial resistance among its key target pathogens in sub-Saharan Africa [8]. The conundrum of how cotrimoxazole works has led to recent interest in assessing its impact on immune activation, which is a cardinal feature of HIV infection. Soluble and cellular markers of immune activation have been associated with morbidity and mortality independent of CD4 cell count in numerous studies across diverse settingsC. D. B. is funded by a Sir Henry Dale Postdoctoral Research Fellowship awarded by Wellcome and the Royal Society (number 206225/Z/17/Z). A. J. P. is funded by Wellcome (108065/Z/15/Z)