Effects of Co-Trimoxazole on Microbial Translocation in HIV-1-Infected Patients Initiating Antiretroviral Therapy

AIDS Res Hum Retroviruses. 2015 Aug;31(8):830-6. doi: 10.1089/AID.2014.0366. Epub 2015 Jun 15.


Microbial translocation (MT) contributes to immune activation during HIV-1 infection, and persists after initiation of antiretroviral therapy (ART). We investigated whether levels of MT markers are influenced by the use of co-trimoxazole (TMP-SMX) in HIV-1 patients. Plasma samples were obtained from HIV-1-infected patients initiating ART with (n=13) or without (n=13) TMP-SMX prophylaxis. Markers of MT [lipopolysaccharide-binding protein (LBP), lipopolysaccharide (LPS), soluble CD14 (sCD14), and intestinal fatty acid binding protein (I-FABP)] were assessed at baseline (BL), at 1 month, and at 1 year by the Limulus Amebocyte Lysate Assay or ELISA. BL levels of LBP were elevated in both categories of patients; they were highest in patients starting ART and TMP-SMX (median, μg/ml: 36.7 vs. 4.3, respectively, p=0.001) and correlated inversely with CD4(+) T cell counts (ρ=-0.65; p=0.005). Patients receiving ART and TMP-SMX had a significant reduction in LBP between BL and 1 year (median, μg/ml: 36.7 vs. 11.1; p=0.003). In contrast, levels of LPS at BL were lower in patients starting ART and TMP-SMX compared to those without TMP-SMX (median, pg/ml: 221 vs. 303 respectively; p=0.002) and did not change at 1 year. The increased BL levels of sCD14 had declined in both groups at 1 year. No difference in I-FABP levels was found between BL and 1 year. Concomitant use of ART and TMP-SMX reduces microbial translocation markers LBP and sCD14, probably due to its impact on the gut microbiota. Effective ART for 1 year does not restore gut-blood barrier dysfunction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute-Phase Proteins
  • Adult
  • Aged
  • Animals
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Retroviral Agents / therapeutic use
  • Antibiotic Prophylaxis / methods*
  • Bacterial Translocation / drug effects*
  • Biomarkers / blood
  • Carrier Proteins / blood
  • Fatty Acid-Binding Proteins / blood
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV-1 / isolation & purification
  • Humans
  • Lipopolysaccharide Receptors / blood
  • Lipopolysaccharides / blood
  • Male
  • Membrane Glycoproteins / blood
  • Middle Aged
  • Retrospective Studies
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / administration & dosage*


  • Acute-Phase Proteins
  • Anti-Bacterial Agents
  • Anti-Retroviral Agents
  • Biomarkers
  • Carrier Proteins
  • Fatty Acid-Binding Proteins
  • Lipopolysaccharide Receptors
  • Lipopolysaccharides
  • Membrane Glycoproteins
  • lipopolysaccharide-binding protein
  • Trimethoprim, Sulfamethoxazole Drug Combination