WHO first recommended cotrimoxazole prophylaxis for all infants who are HIV-exposed but uninfected (HEU) in 2000, given the ability of this treatment to prevent mortality from pneumocystis pneumonia in adults living with HIV. Over the last 21 years, evidence has been generated from the use of cotrimoxazole prophylaxis in infants who are HEU, including two randomised controlled trials, which have shown no clinical benefit and an increase in antibiotic resistance and microbiome dysbiosis. Additionally, improvements in health care over the last two decades in terms of antiretroviral treatment and prophylaxis for mothers and infants, and notably improved vaccination programmes, have substantially reduced the risk of HIV transmission and the overall morbidity and mortality of infants who are HEU from pneumonia and diarrhoeal diseases. Here, we highlight these changes in health care alongside the unchanged cotrimoxazole prophylaxis guidelines and call for a change in these guidelines on the basis of a public health and ethics approach.

中文翻译：

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针对暴露于艾滋病毒但未感染的婴儿的复方新诺明指南：呼吁对证据采取公共卫生和伦理方法

世界卫生组织于 2000 年首次建议对所有暴露于艾滋病毒但未感染的婴儿 (HEU) 使用复方新诺明进行预防，因为这种治疗能够预防艾滋病毒感染者因肺孢子虫肺炎死亡。在过去 21 年中，在 HEU 婴儿中使用复方新诺明进行预防已经产生了证据，其中包括两项随机对照试验，这些试验显示没有临床益处，并且抗生素耐药性和微生物群失调增加。此外，过去二十年来，在母亲和婴儿的抗逆转录病毒治疗和预防方面医疗保健的改善，以及疫苗接种计划的显着改善，已大大降低了艾滋病毒传播的风险以及因肺炎而患高浓铀的婴儿的总体发病率和死亡率和腹泻疾病。在这里，我们强调医疗保健方面的这些变化以及未改变的复方新诺明预防指南，并呼吁在公共卫生和道德方法的基础上改变这些指南。