Cotrimoxazole Prophylaxis Increases Resistance Gene Prevalence and α-Diversity but Decreases β-Diversity in the Gut Microbiome of Human Immunodeficiency Virus–Exposed, Uninfected Infants
Clinical Infectious Diseases·
- DOI
- 10.1093/cid/ciz1186
- PMID
- 31832638
- PMCID
- PMC7778358
- OpenAlex
- W2994920208
- Study type
- Guideline
- Publisher
- Oxford University Press (OUP)
- Article type
- journal-article
- Integrity
- current
Why this research matters now
Rising antibiotic resistance poses particular concern in low- and middle-income countries with higher perinatal HIV exposure rates and wider cotrimoxazole prophylaxis use. Findings may inform revisions to current infant prophylaxis guidelines.
Structured evidence summary
Research question
The study examined how prophylactic cotrimoxazole treatment affects the gut microbiome and antibiotic resistance genes in HIV-exposed, uninfected infants.
Study design
Randomized trial with whole-metagenome sequencing of 163 stool samples collected longitudinally from 63 HIV-exposed, uninfected infants assigned to receive (n=34) or not receive (n=29) cotrimoxazole prophylaxis.
Population and setting
HIV-exposed, uninfected infants randomized to cotrimoxazole prophylaxis (n=34) or no prophylaxis (n=29), with samples collected over at least six months.
Main findings
Cotrimoxazole prophylaxis did not alter taxonomic or functional pathway diversity but significantly increased antibiotic resistance gene prevalence and within-sample diversity, with effects strengthening over time. Between-sample diversity decreased for taxonomy, functional pathways, and resistance genes in treated infants, consistent with antibiotic selection pressure.
Public-health relevance
Rising antibiotic resistance poses particular concern in low- and middle-income countries with higher perinatal HIV exposure rates and wider cotrimoxazole prophylaxis use. Findings may inform revisions to current infant prophylaxis guidelines.
Important limitations
This summary is limited to the supplied single-article abstract and metadata. Full interpretation of microbiome changes, clinical significance, and generalizability requires access to the complete published article.
GIDS interpretation
The article was classified under AIDS, antimicrobial resistance, health policy, and treatment topics. It addresses a guideline-related intervention (cotrimoxazole prophylaxis in HIV-exposed infants) and contributes evidence on unintended microbiome and resistance outcomes that may inform policy refinement.
Related GIDS surveillance
Literature context does not validate, explain, or change a surveillance signal. Exact and contextual relationships are shown separately.
Evidence relationships
This article has 12 auditable classifier relationships to diseases, places, topics, and study design.