{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:16:11Z","timestamp":1790712971882,"version":"4.1.0"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Co-trimoxazole is used as a prophylaxis for human immunodeficiency virus (HIV) patients to prevent opportunistic infections. Its widespread use results in the emergence of co-trimoxazole resistance, which is a significant problem. This systematic review and meta-analysis determined the pooled prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was applied to report this study. The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the assigned number CRD42024532240. Article search was performed using electronic databases such as PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online. Data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11.0 software. A random-effects model was used to estimate the pooled effect size of co-trimoxazole resistance across studies with a 95% confidence interval. The heterogeneity was checked using I<jats:sup>2<\/jats:sup> statistic. The presence of publication bias was determined using a funnel plot and Egger\u2019s test with a <jats:italic>p<\/jats:italic>-value &amp;lt;0.05 evidence of statistically significant bias. Subgroup and sensitivity analyses were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty-two studies with 5,788 HIV-infected individuals were included. The pooled prevalence of co-trimoxazole resistance was 61.73% (95% CI: 53.10\u201370.37%), with heterogeneity (I<jats:sup>2<\/jats:sup> =\u200987.7%) and statistical significance (<jats:italic>p<\/jats:italic> &amp;lt;\u20090.001). A higher co-trimoxazole resistance was observed in HIV-infected individuals with urinary tract infection; 82.10% (95% CI: 75.03\u201389.17%). Among the bacterial spp., higher resistance to co-trimoxazole was observed in <jats:italic>Escherichia coli<\/jats:italic>; 70.86% (95% CI: 53.44\u201388.27%) followed by <jats:italic>Salmonella<\/jats:italic> spp.; 67.66% (95% CI: 41.51\u201393.81%) and <jats:italic>Proteus<\/jats:italic> spp.; 66.23% (95% CI: 34.65\u201397.82%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There is a higher prevalence of co-trimoxazole resistance in HIV-infected individuals in Ethiopia. This alarms WHO\u2019s recommendation of co-trimoxazole prophylaxis guidelines to review and update it. Additionally, a nationwide assessment of co-trimoxazole resistance in Ethiopia as a whole is required.<\/jats:p><jats:p><jats:bold>Systematic review registration<\/jats:bold>: identifier: CRD42024532240.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1418954","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T04:43:35Z","timestamp":1720673015000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Prevalence of co-trimoxazole resistance among HIV-infected individuals in Ethiopia: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"11","author":[{"given":"Muluneh","family":"Assefa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getu","family":"Girmay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1002\/9781119826781.ch5","volume-title":"Sexually transmissible Oral diseases","author":"Prabhu","year":"2023"},{"key":"ref2","volume-title":"Global HIV & AIDS statistics \u2014 Fact sheet","year":"2022"},{"key":"ref3","year":""},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e137","DOI":"10.1016\/S2352-3018(15)00005-3","article-title":"Co-trimoxazole prophylaxis in adults, including pregnant women, with HIV: a systematic review and meta-analysis","volume":"2","author":"Suthar","year":"2015","journal-title":"Lancet HIV"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1428","DOI":"10.1016\/S0140-6736(04)17225-5","article-title":"Effect of co-trimoxazole prophylaxis on morbidity, mortality, CD4-cell count, and viral load in HIV infection in rural Uganda","volume":"364","author":"Mermin","year":"2004","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"198","DOI":"10.7196\/SAMJ.2019.v109i4.13877","article-title":"Eligibility for co-trimoxazole prophylaxis among adult HIV-infected patients in South Africa","volume":"109","author":"Takuva","year":"2019","journal-title":"S Afr Med J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e26079","DOI":"10.1002\/jia2.26079","article-title":"Co-trimoxazole prophylaxis for children who are HIV-exposed and uninfected: a systematic review","volume":"26","author":"Wedderburn","year":"2023","journal-title":"J Int AIDS Soc"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"103874","DOI":"10.1155\/2015\/103874","article-title":"Resistance to Cotrimoxazole and other antimicrobials among isolates from HIV\/AIDS and non-HIV\/AIDS patients at Bugando medical Centre, Mwanza, Tanzania","volume":"2015","author":"Marwa","year":"2015","journal-title":"AIDS Res Treat"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"8","author":"Moher","year":"2010","journal-title":"Int J Surg"},{"key":"ref10","volume-title":"The Joanna Briggs institute critical appraisal tools for use in JBI systematic reviews checklist for analytical cross sectional studies","year":"2017"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1177\/1474515120944014","article-title":"Meta-analysis: how to quantify and explain heterogeneity?","volume":"19","author":"Ruppar","year":"2020","journal-title":"Eur J Cardiovasc Nurs"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1002\/jrsm.1468","article-title":"Investigating and dealing with publication bias and other reporting biases in meta-analyses of health research: a review","volume":"12","author":"Page","year":"2021","journal-title":"Res Synth Methods"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e0196722","DOI":"10.1371\/journal.pone.0196722","article-title":"Pharyngeal colonization and drug resistance profiles of Morraxella catarrrhalis, Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae among HIV infected children attending ART Clinic of Felegehiwot referral hospital, Ethiopia","volume":"13","author":"Mulu","year":"2018","journal-title":"PLoS One"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1556\/030.66.2019.014","article-title":"Methicillin-resistant Staphylococcus aureus colonization in HIV patients of Arba Minch province, Ethiopia: carriage rates, antibiotic resistance, and biofilm formation","volume":"66","author":"Manilal","year":"2019","journal-title":"Acta Microbiol Immunol Hung"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e0243054","DOI":"10.1371\/journal.pone.0243054","article-title":"Does cotrimoxazole prophylaxis in HIV patients increase the drug resistance of pneumococci? 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