PURPOSE: To estimate the impact of routine cotrimoxazole prophylaxis on the mortality and morbidity of HIV-positive tuberculosis patients, irrespective of CD4 counts.
METHODS: Cotrimoxazole prophylaxis, in addition to routine care, was offered to all TB patients from the time they were detected as HIV-positive and for 12 months thereafter in the years 2006 and 2007 in the DOTS center of BR Singh Hospital, Kolkata, India. In a cohort analysis the end-of-treatment outcomes, morbidity and mortality were compared between HIV-infected tuberculosis patients registered in 2004–2005 (when no cotrimoxazole prophylaxis was offered) and those registered in 2006–2007. Febrile events, diarrheal episodes or events requiring hospital admission were taken as measures of morbidity. Case ascertainment, TB treatment and outpatient follow-up were identical in all years. Patients with advanced HIV disease were excluded from the study.
RESULTS: 265 and 284 TB patients were registered in 2004–2005 and 2006–2007 respectively. Of them 13 (4.9%) and 22 (7.7%) was HIV positive respectively. 2 patients were excluded from the study from the intervention group as they had advanced HIV disease. The end-of treatment outcomes were similar in both control and intervention groups. There was no statistical difference in mortality rates (30.76% vs 15%, p=0.19) between the two groups. 75% of the deaths occurred during treatment of tuberculosis in the control group as compared to only 33.33% in the intervention group. However there was statistically significant difference (p<0.0005) between the morbidity rates of two groups.
CONCLUSION: Cotrimoxazole chemoprophylaxis does not reduce mortality in HIV-infected tuberculosis patients in eastern India but contributes significantly to a reduction in morbidity. Larger studies with long-term evaluation are necessary in this regard.
CLINICAL IMPLICATIONS: Cotrimoxazole being a low cost drug with easy availability should be used routinely in all Tuberculosis patients with HIV infection in resource limited settings.
DISCLOSURE: Shantanu Das, No Financial Disclosure Information; No Product/Research Disclosure Information