title: Global Policy Review of Recommendations on Cotrimoxazole Prophylaxis among People Living with HIV.
abstract: The Joint United Nations Programme on HIV/AIDS (UNAIDS) Treatment 2015 calls for expanded access to HIV care and treatment, including cotrimoxazole preventive therapy (CPT), for prevention of HIV-related morbidity and mortality. We review 115 national guidelines from 92 countries for recommendations on CPT for adults and adolescents and determine the level of consistency with the World Health Organization (WHO) guidelines. Of the 66 countries with recommendations, 5 (8%) countries recommend lifelong CPT for people living with HIV; 19 (29%) countries recommend a CD4 count threshold of ≤350 cells/mm(3) or WHO clinical stages III and IV or II, III, and IV; and 19 (29%) countries recommend a CD4 count threshold of ≤200 cells/mm(3). Of the 48 countries with recommendations on discontinuing CPT, 25 (52%) countries recommend discontinuation of cotrimoxazole when the CD4 count is >200 cells/mm(3). World Health Organization guidelines offer countries flexibility on the use of CPT, and countries are recommending a wide range of CD4 counts and WHO clinical stage criteria for prophylaxis initiation and discontinuation.
authors.affiliation: Special Initiatives, Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland somyagupta17@gmail.com.
authors.forename: Somya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Special Initiatives, Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
authors.forename: Reuben
authors.initials: R
authors.lastname: Granich
authors.affiliation: Global Financing Mechanisms and Collaboration Division, UNAIDS, Geneva, Switzerland.
authors.forename: Bradley
authors.initials: B
authors.lastname: Hersh
authors.affiliation: Special Initiatives, Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lepere
authors.affiliation: Special Initiatives, Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland.
authors.forename: Badara
authors.initials: B
authors.lastname: Samb
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D018791:CD4 Lymphocyte Count; D005260:Female; D014943:Global Health / Q000331:legislation & jurisprudence*; D015658:HIV Infections / Q000188:drug therapy*; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D011247:Pregnancy; D012720:Severity of Illness Index; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: CD4 count; WHO clinical stage; cotrimoxazole; policy