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

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


Cotrimoxazole (CTX) is a fixed-dose combination of two antimicrobial agents (sulfamethoxazole and trimethoprim) that targets a variety of Gram-positive and Gram-negative organisms, fungi and protozoa, preventing Pneumocystis jirovecci pneumonia (PCP), malaria and toxoplasmosis among other infections. CTX prophylaxis is currently recommended by the World Health Organization (WHO) as a feasible, well-tolerated, and cost-effective intervention to prevent opportunistic infections (OIs) and other common infections for people living with HIV.

In 2006, WHO guidelines on the use of CTX prophylaxis in resource-limited settings were issued, with the directive to be implemented as an integral component of the HIV care package and as a key element of pre–antiretroviral therapy (ART) care. The 2006 guidelines also addressed CTX prophylaxis in HIV-exposed infants and childreni. With the expanded access and earlier initiation of ART, there is a need to review and revise the recommendations on CTX prophylaxis in HIV care.

A Guideline Development Group was formed under the norms and rules of the WHO Guidelines Review Committee (GRC) to ensure that guidelines are of a high methodological quality and are developed through a transparent, evidence-based decision-making process. In the weeks previous to the meeting the group had the opportunity to review background information including clinical trials to analyze existing relevant evidence in this field.