• ketut suryana Department of Internal Medicine, Wangaya Hospital in Denpasar, Bali, Indonesia.
  • Hamong Suharsono Department of Internal Medicine, Wangaya Hospital in Denpasar, Bali, Indonesia.
  • Dwijo Anargha Sindhughosa Department of Internal Medicine, Wangaya Hospital in Denpasar, Bali, Indonesia.


Objective: To evaluate whether co-trimoxazole preventive therapy (CPT) and other contributing factors, among people living with HIV/AIDS (PLWHA) on antiretroviral (ARV) are effective to reduce active pulmonary tuberculosis (APT) at Wangaya Hospital, Denpasar, Bali, Indonesia.

Methodology: A prospective cohort study was conducted to evaluate the use of CPT in reducing APT. In this study, 403 PLWHA on ARV 151 participants accepted CPT as the first group and 252 PLWHA refused CPT as the second group. Eight participants among the first group and 48 participants among the second group were confirmed APT. Revisits were scheduled every a month to replenish pills and to confirm APT. The CPT effectiveness, sociodemography and laboratory, and reducing APT risk after prospective cohort entry were analyzed using Chi-square with significant p<0.05. Statistical software package SPSS 15.0 was used for statistical analysis.

Results: Two hundred fifty-one (62.2%) of the participants were males and 152 (37.8%) females. Eight (2.0%) of the first group were confirmed APT and 48 (12.0%) of the second group were confirmed APT (p=0.004). In bivariate analysis (Chi-square), we found that sex (p=0.019), smoking (p=0.000), alcohol consumption (p=0.000), previous history of tuberculosis (TB) (p=0.000), and CD4 cell counts (<69 cell/μL) (p=0.002) were significant APT risk factors. There was significantly less APT risk among the participants who accepted CPT compared with participants refused CPT (p=0.002).

Conclusions: This study found that CPT was significantly associated with reduce of APT risk in PLWHA. Furthermore, there were significantly added the preventive effect of CPT; sex, smoking, alcohol consumption, previous history of TB, and CD4 cell counts.

Keywords: Human immunodeficiency virus, Co-trimoxazole preventive therapy, Active pulmonary tuberculosis

Author Biography

Hamong Suharsono, Department of Internal Medicine, Wangaya Hospital in Denpasar, Bali, Indonesia.

Department of Biochemistry, Veterinary Faculty of Udayana University in Denpasar, Bali, Indonesia


1. Sisay M, Bute D, Edessa D, Mengistu G, Amare F, Gashaw T, et al. Appropriateness of cotrimoxazole prophylactic therapy among HIV/AIDS patents in public hospitals in Eastern Ethiopia: A retrospective evaluation of clinical practice. Front Pharmacol 2018;9:727.
2. Gebresillassie BM, Gebeyehu MB, Abegaz TM, Erku DA, Mekuria AB, Tadesse YD. Evaluation of cotrimoxazole use as a preventive therapy among patients living with HIV/AIDS in Gondar University referral hospital, Northwestern Ethiophia: A retrospective cross-sectional study. HIV AIDS (Auckl) 2016;8:125-33.
3. Hasse B, Walker AS, Fehr J, Furrer H, Hoffmann M, Battegay M, et al. Co-trimoxazole prophylaxis is associated with reduced risk of incident tuberculosis in participant in the Swiss HIV cohort study. Antimicrob Agents Chemother 2014;58:2363-8.
4. Diriba L, Pharm B, Worku F, Girma T. Evaluation of prophylactic use of cotrimoxazole for people living with HIV/AIDS in Jimma University specialized hospital, Southwest Ethiopia. Ethiop J Health Sci 2008;18:59-64.
5. Polyak CS, Yuhas K, Singa B, Khaemba M, Walson J, Richardson BA, et al. Cotrimoxazole prophylaxis discontinuation among antiretroviral treated HIV-1 infected adults in Kenya: A randomized non inferiority trial. PLoS Med 2016;13:e1001934.
6. Sibanda EL, Weller IV, Hakim JG, Cowan FM. Does trimethoprim-sulfamethoxazole prophylaxis for HIV induce bacterial resistance to other antibiotic classes? Results of a systematic review. Clin Infect Dis 2011;52:1184-94.
7. Huang TS, Kunin CM, Yan BS, Chen YS, Lee SSJ, Syu WJ. Susceptibility of Mycobacterium tuberculosis to sulfamethoxazole, trimethoprim and ther combnation over a 12 year period in Taiwan. J Antimicrob Chemother 2012;67:633-7.
8. Ong W, Sievers A, Leslie DE. Mycobacterium tuberculosis and sulfamethoxazole susceptibility. Antimicrob Agents Chemother 2010;54:2748-9.
9. Forgacs P, Wengenack NL, Hall L, Zimmerman SK, Silverman ML, Roberts GD. Tuberculosis and trimethoprim-sulfamethoxazole. Antimicrob Agents Chemother 2009;54:2748-9.
10. Gupta S, Granich R, Hersh B, Lepere P, Samb B. Global policy review of recommendations on cotrimoxazole prophylaxis among people living with HIV. J Int Assoc Provid AIDS Care 2014;13:397-401.
11. Watera C, Todd J, Muwonge R, Whitworth J, Nakiyingi-Miiro J, Brink A, et al. Feasibility and effectiveness of cotrimoxazole prophylaxis for HIV-1 infected adults attending an HIV/AIDS clinic in Uganda. J Acquir Immune Defic Syndr 2006;42:373-8.
12. Date AA, Vitoria M, Granich R, Banda M, Fox MY, Gilks C. Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV. Bull World Health Organ 2010;88:253-9.
13. Boeree MJ, Sauvageot D, Banda HT, Harries AD, Zijlstra EE. Efficacy and safety of two dosages of cotrimoxazole as preventive treatment for HIV-infected Malawian adults with new smear-positive tuberculosis. Trop Med Int Health 2005;10:723-33.
14. Macingwana L, Baker B, Ngwane AH, Harper C, Cotton MF, Hesseling A, et al. Sulfamethoxazole enhances the antimycobacterial activity of rifampicin. J Antimicrob Chemother 2012;67:2908-11.
15. Raizada N, Chauhan LS, Babu S, Thakur R, Khera A, Wares DF,et al. Linking HIV-infected TB patients to cotrimoxazole prophylaxis and antiretroviral treatment in India. PLoS One 2009;4:e5999.
16. Denue BA. Knowledge regarding co-trimoxazolepreventive therapy among patients who are HIV positive in a tertiary health facility, Northeastern Nigeria. Sub Saharan Afr J Med 2018;4:31-6.
17. Church JA, Fitzgerald F, Walker AS, Gibb DM, Prendergast AJ. The expanding role of co-trimoxazole in developing countries. Lancet Infect Dis 2014;15:327-39.
18. Walker AS, Ford D, Gilks CF, Munderi P, Ssali F, Reid A, et al. Daily co-trimoxazole prophylaxis in severely immunosuppressed HIV-infected adults in Africa started on combination antiretroviral therapy: An observational analysis of the DART cohort. Lancet 2010;375:1278-86.
19. Ku SW, Jiamsakul A, Joshi K, Pasayan MK, Widhani A, Chaiwarith R, et al. Cotrimoxazole prophylaxis decreases tuberculosis risk among Asian patients with HIV. J Int AIDS Soc 2019;22:e25264.
20. Kibret KT, Yalew AW, Belaineh BG, Asres MM. Determinant factors associated with occurrence of tuberculosis among adult people living with HIV after antiretroviral treatment initiation in Addis Ababa, Ethiopia: A case control study. PLoS One 2013;8:e64488.
21. Taha M, Deribew A, Tessema F, Assegid S, Duchatea L, Colebunders R. Risk factors of active tuberculosis in people living with HIV/AIDS in Southwest Ethiopia: A case control study. Ethiop J health Sci 2011;21:131-9.
22. Horne DJ, Campo M, Ortiz JR, Oren E, Arentz M, Crothers K, et al. Association between smoking and latent tuberculosis in the U.S. population: An analysis of the national health and nutrition examination survey. PLoS One 2012;7:e49050.
23. Piao WH, Campagnolo D, Dayao C, Lukas RJ, Wu J, Shi FD. Nicotine and inflammatory neurological disorders. Acta Pharmacol Sin 2009;30:715-22.
24. Mehta H, Nazzal K, Sadikot RT. Cigarette smoking and innate immunity. Inflamm Res 2008;57:497-503.
25. Alemu YM, Awoke W, Smiths AW. Determinants for tuberculosis in HIV-infected adults in Northwest Ethiopia: A multicentre case-control study. BMJ Open 2016;6:e009058.
26. Szobo G, Saha B. Alcohol’s effect on host defense. Alcohol Res 2012;37:159-70.
27. Lonnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C. Alcohol use a risk factor for tuberculosis-a systematic review. BMC Public Health 2008;8:289.
28. Hassani AS, Marston BJ, Kaplan JE. Assessment of the impact of cotrimoxazole prophylaxis on key outcomes among HIV-infected adults in low-and middle-income countries: A systematic review. J Acquir Immune Defic Syndr 2015;68 Suppl 3:S257-69.
29. Nunn AJ, Mwaba P, Chintu C, Mwinga A, Darbyshire JH, Zumla A. Role of co-trimoxazole prophylaxis in reducing mortality in HIV infected adults being treated for tuberculosis: Randomized clinical trial. BMJ 2008;337:a257.
30. Hoffman CJ, Chaisson RE, Martinson NA. Cotrimoxazole prophylaxis and tuberculosis risk among people living with HIV. PLoS One 2014;9:e83750.
31. Djergjii M, Bushati J, Harxhi A, Hafizi H, Pipero P. Tuberculosis in HIV/AIDS patients. Adv Tech Clin Microbiol 2017;1:16.
32. Giri PA, Desphande JD, Phalke DB. Prevalence of pulmonary tuberculosis among HIV positive patients attending antiretroviral therapy clinic. N Am J Med Sci 2013;5:367-70.
33. Skogmar S, Schon T, Balcha TT, Jemal ZH, Tibesso G, Björk J, et al. CD4 cell levels during treatment for tuberculosis (TB) in Ethiopian adults and clinical markers associated with CD4 lymphocytopenia. PLoS One 2013;8:e83270.
34. Tariku Y, Yaya Y, Jerene D, Tamiso A. Incidence of opportunistic infections among adult HIV positive people receiving co-trimoxazole prophylaxis. Int J Public Health Sci 2015;4:172-9.
35. Vilcheze C, Jacobs WR Jr. The combination of sulfamethoxazole, trimethoprim, and isoniazid or rifampin is bactericidal and prevents the emergence of drug resistance in mycobacterium tuberculosis. Antimicrob Agents Chemother 2012;56:5142-8.
65 Views | 83 Downloads
How to Cite
suryana, ketut, H. Suharsono, and D. A. Sindhughosa. “CO-TRIMOXAZOLE PREVENTIVE THERAPY REDUCES ACTIVE PULMONARY TUBERCULOSIS RISK IN PEOPLE LIVING WITH HIV/AIDS ON ANTIRETROVIRAL AT WANGAYA HOSPITAL IN DENPASAR, BALI, INDONESIA: A PROSPECTIVE COHORT STUDY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 4, Feb. 2020, pp. 96-100, doi:10.22159/ajpcr.2020.v13i4.36844.
Original Article(s)