title: Cotrimoxazole prophylaxis and antiretroviral therapy: an observational cohort study in China.
abstract: OBJECTIVE
  To assess if cotrimoxazole prophylaxis administered early during antiretroviral therapy (ART) reduces mortality in Chinese adults who are infected with human immunodeficiency virus (HIV).
  
  
  METHODS
  We did a retrospective observational cohort study using data from the Chinese national free antiretroviral database. Patients older than 14 years who started ART between 1 January 2010 and 31 December 2012 and had baseline CD4+ T-lymphocyte (CD4+ cell) count less than 200 cells/µL were followed until death, loss to follow-up or 31 December 2013. Hazard ratios (HRs) for several variables were calculated using multivariate analyses.
  
  
  RESULTS
  The analysis involved 23 816 HIV-infected patients, 2706 of whom died during the follow-up. Mortality in patients who did and did not start cotrimoxazole during the first 6 months of ART was 5.3 and 7.0 per 100 person-years, respectively. Cotrimoxazole was associated with a 37% reduction in mortality (hazard ratio, HR: 0.63; 95% confidence interval, CI: 0.56-0.70). Cotrimoxazole in addition to ART reduced mortality significantly over follow-up lasting 6 months (HR: 0.65; 95% CI: 0.59-0.73), 12 months (HR: 0.58; 95% CI: 0.49-0.70), 18 months (HR: 0.49; 95% CI: 0.38-0.63) and 24 months (HR: 0.66; 95% CI: 0.48-0.90). The mortality reduction was evident in patients with baseline CD4+ cell counts less than 50 cells/µL (HR: 0.60; 95% CI: 0.54-0.67), 50-99 cells/µL (HR: 0.66; 95% CI: 0.56-0.78) and 100-199 cells/µL (HR: 0.78; 95% CI: 0.62-0.98).
  
  
  CONCLUSIONS
  Cotrimoxazole prophylaxis started early during ART reduced mortality and should be offered to HIV-infected patients in low- and middle-income countries.
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Yasong
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Yi
authors.initials: Y
authors.lastname: Wen
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Ye
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Decai
authors.initials: D
authors.lastname: Zhao
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Dou
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Global AIDS Program, Centers for Disease Control and Prevention, United States Embassy, Beijing, China .
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.affiliation: Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Rd, Beijing 100050, China .
authors.forename: Fujie
authors.initials: F
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D018791:CD4 Lymphocyte Count; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D044966:Anti-Retroviral Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
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