Grant: Project Grant

Adults with advanced HIV disease have very weak immune systems and are at high risk of dying from infections, especially in the first few months after starting HIV treatment. Even though they usually receive preventive antibiotics many still get sick from bacterial infections. A large research study called REVIVE is currently underway and is testing whether giving an additional antibiotic, azithromycin, for four weeks when HIV treatment starts can reduce these deaths compared to placebo. What's the concern? Using antibiotics leads to antimicrobial resistance. This means bacteria can become harder to treat and increase the risk of severe illness and death. This does not only affect the person taking the antibiotics, but also the wider community. Before recommending azithromycin for all people with advanced HIV disease, we need to make sure it doesn't cause more harm by increasing resistance than benefit. What is this study doing? This study uses the REVIVE trial to look specifically at antimicrobial resistance. It will include over 440 participants of the REVIVE trial in sub-Saharan Africa with advanced HIV. With their consent, swabs will be collected from their nose, throat, and rectum at the start of the azithromycin, after 4 weeks (stop of azithromycin), and again after 24 weeks (5 months after stopping azithromycin/placebo). These samples will be tested in a laboratory to: •check for specific bacteria, •see if these bacteria are resistant to specific antibiotics What will this study tell us? The results will show us if azithromycin is safe to give to thousands of adults with advanced HIV disease to reduce the number of deaths. It will also give doctors valuable information about the different types of bacteria in adults with advanced HIV disease. This knowledge can guide better treatment decisions, improve infection prevention, and help protect antibiotics for future use.