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Cotrimoxazole prophylaxis — DTM&H MCQ

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HardHIV/AIDS in tropical settingsCotrimoxazole prophylaxisDTM&H

A man in Kenya with HIV-associated tuberculosis starts ART and daily co-trimoxazole. Two years later he is clinically stable with viral suppression and CD4 520 cells/mm3, but he remains in a setting with high malaria and severe-bacterial-infection prevalence. What does WHO guidance support?

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Correct answer: C — Continue co-trimoxazole while he remains in the high-prevalence setting

The best answer is “Continue co-trimoxazole while he remains in the high-prevalence setting”. WHO supports lifelong prophylaxis for people with HIV in settings where malaria or severe bacterial infection is highly prevalent, including those with HIV-associated tuberculosis. Immune recovery does not override that contextual recommendation. Chloroquine, azithromycin and stopping at tuberculosis completion are not equivalent strategies.

Reference: WHO TB Knowledge Sharing: co-trimoxazole prophylaxis in HIV care: https://tbksp.who.int/en/node/2778