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Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire: a prospective cohort study.

AbstractBACKGROUND:
Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and/or cotrimoxazole in Abidjan, Côte d'Ivoire.
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.
AuthorsAïda 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
JournalBMC infectious diseases (BMC Infect Dis) Vol. 15 Pg. 317 (Aug 07 2015) ISSN: 1471-2334 [Electronic] England
PMID26248711 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Anti-HIV Agents
  • Antimalarials
  • Trimethoprim, Sulfamethoxazole Drug Combination
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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