HIV/AIDS

Guideline Development Group Meeting on Cotrimoxazole prophylaxis in the context of HIV

Meeting report - 19-21 November 2013
World Health Organization, Geneva, Switzerland


Conclusions

At the conclusion of the three-day Guideline Consensus Meeting, the GDG maintained, as in 2006, that CTX prophylaxis remains an affordable, safe, and feasible intervention for resource-limited countries that should be scaled up as part of standard care for people living with HIV and HIV-exposed infants.

To update recommendations consideration was given to an expansion of CTX prophylaxis beyond the use of this intervention in reducing HIV-associated mortality impact in people with low CD4 counts to a broader impact on morbidity. Specifically, the use of CTX prophylaxis in the context of malaria, severe bacterial infections (SBIs), and tuberculosis (TB) was more adequately addressed in these recommendations (see annex 3).

To update recommendations consideration was given to an expansion of CTX prophylaxis beyond the use of this intervention in reducing HIV-associated mortality impact in people with low CD4 counts to a broader impact on morbidity. Specifically, the use of CTX prophylaxis in the context of malaria, severe bacterial infections (SBIs), and tuberculosis (TB) was more adequately addressed in these recommendations (see annex 3).

Based on this review, WHO will update the global recommendations on CTX prophylaxis use in the context of HIV as indicated in this report, and will call for national health authorities to disseminate these updated recommendations widely. Importantly, advocacy to address these research gaps will be critical, and a diverse group of actors, particularly at the community-level, will be instrumental in implementing these new recommendations.

The new recommendations and research gaps on the use of CTX prophylaxis will be included as part of a modular chapter of the 2013 WHO consolidated guidelines on use of ARVs planned for the fall, 2014.

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