Improved Survival with Multiple Antimicrobial Prophylaxis in Severely Immunosuppressed Patients Initiating ART

In HIV positive patients, mortality is highest in those who have low CD4 cell counts. The open-label REALITY (Reduction of Early Mortality in HIV Infected Adults and Children Starting Antiretroviral Therapy) trial, conducted from 2013 to 2015 in 1805 patients ≥5 years old from Uganda, Zimbabwe, Malawi, and Kenya assessed whether enhanced antimicrobial prophylaxis, started when initiating antiretroviral therapy (ART), would reduce mortality. The enhanced antimicrobial prophylaxis regimen included trimethoprim-sulfamethoxazole plus 12 weeks of isoniazid-pyridoxine, 12 weeks of fluconazole, 5 days of azithromycin, and a single dose of albendazole. Standard prophylaxis was trimethoprim-sulfamethoxazole for 12 weeks.

At baseline, the median CD4 c…