Abstract | BACKGROUND: METHODS: All HIV-infected children <16 years, followed-up in the IeDEA West-African paediatric cohort (pWADA) in Abidjan, were prospectively included from May to August 2012, the rainy season. Children presenting signs suggesting malaria had a thick blood smear and were classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model. RESULTS: Overall, 1117 children were included, of whom 89 % were ART-treated and 67 % received cotrimoxazole. Overall, there were 51 malaria events occurring in 48 children: 28 confirmed and 23 probable; 94 % were uncomplicated malaria. The overall IR of malaria (confirmed and probable) was 18.3/100 CY (95 % CI: 13.3-23.4), varying from 4.2/100 CY (95 % CI: 1.1-7.3) in children on ART and cotrimoxazole to 57.3/100 CY (95 % CI: 7.1-107.6) for those receiving no treatment at all. In univariate analysis, age < 5 years was significantly associated with a 2-fold IR of malaria compared to age >10 years (incidence rate ratio [ IRR] = 2.18, 95 % CI: 1.04-4.58). Adjusted for severe immunodeficiency, cotrimoxazole reduced significantly the IR of first malarial episode (adjusted IRR [aIRR] = 0.13, 95 % CI: 0.02-0.69 and aIRR = 0.05, 95 % CI:0.02-0.18 in those off and on ART respectively). Severe immunodeficiency increased significantly the malaria IR (aIRR = 4.03, 95 % CI: 1.55-10.47). When considering the IR of confirmed malaria only, this varied from 2.4/100 CY (95 % CI: 0.0-4.8) in children on ART and cotrimoxazole to 34.4/100 CY (95 % CI: 0.0-73.3) for those receiving no treatment at all. In adjusted analyses, the IR of malaria in children on both cotrimoxazole and ART was significantly reduced (aIRR = 0.05, 95 % CI: 0.01-0.24) compared to those receiving no treatment at all. CONCLUSIONS:
Cotrimoxazole prophylaxis was strongly protective against the incidence of malaria when associated with ART in HIV-infected children. Thus, these drugs should be provided as widely and durably as possible in all HIV-infected children <5 years of age.
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Authors | Aïda Mounkaila Harouna, Madeleine Amorissani-Folquet, François Tanoh Eboua, Sophie Desmonde, Sylvie N'Gbeche, Edmond Addi Aka, Kouakou Kouadio, Brou Kouacou, Karen Malateste, Clarisse Bosse-Amani, Patrick Ahuatchi Coffie, Valeriane Leroy, IeDEA paediatric West African Study Group |
Journal | BMC infectious diseases
(BMC Infect Dis)
Vol. 15
Pg. 317
(Aug 07 2015)
ISSN: 1471-2334 [Electronic] England |
PMID | 26248711
(Publication Type: Journal Article, Research Support, N.I.H., Extramural)
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Chemical References |
- Anti-HIV Agents
- Antimalarials
- Trimethoprim, Sulfamethoxazole Drug Combination
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Topics |
- Anti-HIV Agents
(therapeutic use)
- Antimalarials
(therapeutic use)
- Child
- Child, Preschool
- Cohort Studies
- Cote d'Ivoire
(epidemiology)
- Female
- Follow-Up Studies
- HIV Infections
(complications, drug therapy)
- Humans
- Incidence
- Malaria
(complications, drug therapy, epidemiology)
- Male
- Prospective Studies
- Regression Analysis
- Trimethoprim, Sulfamethoxazole Drug Combination
(therapeutic use)
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