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

Abstract

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.

Burden of asymptomatic malaria, anemia and relationship with cotrimoxazole use and CD4 cell count among HIV1-infected adults living in Gabon, Central Africa

“…The use of cotrimoxazole has been associated with a lower risk of malaria in children, pregnant women, or severely immunocompromised patients; its discontinuation also increases malaria prevalence and parasitemia [6,15,19,31]. In this study, the prevalence of malaria among participants who were not under CTX prophylaxis was twofold higher than those from individuals who were under otrimoxazole prophylaxis (8.3% vs. 4.1%).…”

“…Furthermore, there were more patients under CTX in the PLHIV group with no malaria than in the P. falciparum-infected PLHIV group. Recently, this sulfa combination drug was recommended to all PLHIV living in malaria endemic countries due to its recognized activity against protozoal parasites, more precisely the Plasmodium species [19,20,32]. This recommendation was not established in Gabon at the time of the study period.…”

“…This expected prevalence was based on the assumption that the prevalence of positive blood smear will be at least comparable to the last reported prevalence (13.9%) observed in Dienga Gabon. The literature review highlighted frequencies of asymptomatic malaria in PLHIV varying from 2.2 to 12% [6,18,19]. Given that, when these prevalence were taken into account, the sample size calculation gave a lower minimum size than that obtained with the prevalence of asymptomatic malaria found in Gabon, the latter was used for the calculation.…”

“…Anemia, a consequence of the silent parasite multiplication, would also be frequent among them. Together with sulfadoxine-pyrimethamine which is used for malaria prevention during pregnancy, CTX use can also select drug resistant parasites whose circulation would also contribute to the persistence of malaria transmission [18,19]. Little is known about CTX prophylaxis coverage among HIV infected individuals, as well as malaria-HIV co-infection prevalence in Gabon.…”

Prescription of Antibacterial Drugs for HIV-Exposed, Uninfected Infants, Malawi, 2004–2010

“…CPT for participants in the BAN study was implemented in June 2006. Several analyses, using data from the BAN study and from other studies, have shown CPT to be associated with reduced subclinical malaria ( 23 ), lower rates of illness and death caused by infectious diseases ( 24 – 26 ), and reduced incidence of severe anemia ( 27 ). The antibacterial properties of cotrimoxazole are probably the cause of the observed association between CPT and reduced overall antibacterial prescriptions.…”