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Clin Infect Dis. 2017 Aug 15;65(4):575-580. doi: 10.1093/cid/cix367.

Co-trimoxazole Prophylaxis, Asymptomatic Malaria Parasitemia, and Infectious Morbidity in Human Immunodeficiency Virus-Exposed, Uninfected Infants in Malawi: The BAN Study.

Author information

1
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
2
Division of Infectious Diseases, Department of Medicine, School of Medicine.
3
Carolina Population Center, University of North Carolina at Chapel Hill, North Carolina, USA.
4
Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Parktown, South Africa.
5
University of North Carolina Project-Malawi, Lilongwe.
6
Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA

Abstract

Background:

Human immunodeficiency virus (HIV)-exposed infants are disproportionately at risk of morbidity and mortality compared with their HIV-unexposed counterparts. The role of co-trimoxazole preventive therapy (CPT) in reducing leading causes of infectious morbidity is unclear.

Methods:

We used data from the Breastfeeding, Antiretrovirals and Nutrition (BAN) clinical trial (conducted 2004-2010, Malawi) to assess the association of (1) CPT and (2) asymptomatic malaria parasitemia with respiratory and diarrheal morbidity in infants. In June 2006, all HIV-exposed infants in BAN began receiving CPT (240 mg) from 6 to 36 weeks of age, or until weaning occurred and HIV infection was ruled out. All HIV-exposed, uninfected infants (HEIs) at 8 weeks of age (n = 1984) were included when CPT was the exposure. A subset of HEIs (n = 471) were tested for malarial parasitemia using dried blood spots from 12, 24, and 36 weeks of age. Cox proportional hazards models for recurrent gap-time data were used to examine the association of time-varying exposures on morbidity.

Results:

CPT was associated with a 36% reduction in respiratory morbidity (hazard ratio [HR], 0.64 [95% confidence interval {CI}, .60-.69]) and a 41% reduction in diarrheal morbidity (HR, 0.59 [95% CI, .54-.65]). Having asymptomatic malaria parasitemia was associated with a 40% increase in respiratory morbidity (HR, 1.40 [95% CI, 1.13-1.74]) and a 50% increase in diarrheal morbidity (HR, 1.50 [95% CI, 1.09-2.06]), after adjusting for CPT.

Conclusions:

CPT may have an important role to play in reducing the leading global causes of morbidity and mortality in the growing population of HEIs in malaria-endemic resource-limited settings.

KEYWORDS:

HIV; co-trimoxazole; infant; infectious morbidity; malaria

PMID:
28444232
PMCID:
PMC5850033
DOI:
10.1093/cid/cix367
[Indexed for MEDLINE]
Free PMC Article

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