Time for new recommendations on cotrimoxazole prophylaxis for HIV-exposed infants in developing countries

Coutsoudis, Anna; Coovadia, Hoosen M.; Kindra, Gurpreet

doi:10.2471/blt.10.076422

Cited by 23 publications

(17 citation statements)

References 7 publications

(8 reference statements)

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“…In a nonrandomized study of 363 children in Durban, South Africa, where malaria is not endemic [34], cotrimoxazole prophylaxis was associated with a nonsignificant increase in diarrheal illness, and no significant difference in lower respiratory infections [34]. These findings indicate the need for further study of the role of cotrimoxazole in HIV-exposed uninfected children, particularly given the concerns of microbial resistance with widespread use [35,36]. However, the evidence provided herein by the large BAN cohort provides reassurance as to the benefits of cotrimoxazole prophylaxis for the health and survival of HIV-exposed infants.…”

Section: Discussionmentioning

confidence: 99%

Health outcomes of HIV-exposed uninfected African infants

Kourtis

Wiener

Kayira³

et al. 2013

Aids

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Objectives To evaluate severe (grade 3/4) morbidity and mortality in HIV-exposed, uninfected infants. Design Secondary data analysis of The Breastfeeding, Antiretrovirals, and Nutrition (BAN) clinical trial. Methods BAN randomized 2369 mother–infant pairs to maternal, infant, or no extended antiretroviral prophylaxis during breastfeeding. Morbidity outcomes examined were pneumonia/serious febrile illness, diarrhea/growth faltering, and malaria. Infant death was defined as neonatal (≤ 30 days of life), and postneonatal (31 days to 48 weeks of life). Cox proportional hazards models were used to evaluate the effect of covariates on infant morbidity and mortality. Results The rate of pneumonia/serious febrile illness was highest in the first 12 weeks (0.83/100 person-weeks) before rapidly decreasing; rates of all morbidity outcomes increased after 24 weeks. Rates of pneumonia/serious febrile illness and diarrhea/growth faltering were higher during the rainy season. Prophylactic infant cotrimoxazole significantly decreased the rates of all morbidity outcomes. White blood cell (WBC) count less than 9000/μl at birth was associated with increased diarrhea/growth faltering [adjusted hazard ratio (aHR) 1.73, P = 0.04] and malaria (aHR 2.18, P = 0.02). Low birth weight (2000–2499 g) was associated with neonatal death (aHR 12.3, P <0.001). Factors associated with postneonatal death included rainy season (aHR 4.24, P = 0.002), infant cotrimoxazole (aHR 0.48, P = 0.03), and low infant WBC count at birth (aHR 2.53, P = 0.02). Conclusion Infant morbidity rates increased after 24 weeks, when BAN infants weaned. Introduction of prophylactic cotrimoxazole was associated with reduced rates of morbidity and mortality in HIV-exposed uninfected infants. Unexpectedly, a low WBC count at birth was significantly associated with later infant morbidity and mortality in this cohort.

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Section: Discussionmentioning

confidence: 99%

Health outcomes of HIV-exposed uninfected African infants

Kourtis

Wiener

Kayira³

et al. 2013

Aids

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“…[16,17] Given limited data that CPT may increase risk of diarrheal illness in HIV uninfected infants there is a need to define the optimal duration of cotrimoxazole prophylaxis and possibly reexamine current guidelines. [18]…”

Section: Long-term Impact Of Hiv Exposure On Infant and Childhoodmentioning

confidence: 99%

HIV-exposed infants

Sugandhi

Rodrigues

Kim

et al. 2013

Aids

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Summary Each year over a million infants are born to HIV infected mothers though with scale up of prevention of mother to child transmission (PMTCT) interventions, only 210,000 of the 1.3 million infants born to mothers with HIV/AIDS in 2012 became infected. Current programmatic efforts directed at infants born to HIV-infected mothers are primarily focused on decreasing their risk of infection, but this emphasis on maternal interventions has meant follow-up of exposed infants has been poor. Programs are struggling to retain this population in care until the end of exposure, typically at the cessation of breastfeeding, between 12 and 24 months of age. But HIV exposure is a life-long condition that continues to impact the health and well-being of a child long after exposure has ended. A better understanding of the impact of HIV on exposed infants is needed and new programs and interventions must take into consideration the long-term health needs of this growing population. The introduction of lifelong treatment for all HIV-infected pregnant women is an opportunity to rethink how we provide services adapted for the long-term retention of mother-infant pairs.

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“…[3]–[5] With improved access to maternal HAART during pregnancy and breastfeeding, [6] the recommendation to provide empiric cotrimoxazole prophylaxis for all HIV-exposed infants has been questioned. [7].…”

Section: Introductionmentioning

confidence: 99%

Cotrimoxazole Prophylaxis and Risk of Severe Anemia or Severe Neutropenia in HAART-Exposed, HIV-Uninfected Infants

et al. 2013

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BackgroundProphylactic cotrimoxazole is recommended for infants born to HIV-infected mothers. However, cotrimoxazole may increase the risk of severe anemia or neutropenia.MethodsWe compared the proportion of HIV-exposed uninfected (HIV-EU) infants experiencing incident severe anemia (and separately, severe neutropenia) between a prospective cohort receiving prophylactic cotrimoxazole from 1 to 6 months vs. infants from two prior trials who did not receive cotrimoxazole. Infants were from rural and urban communities in southern Botswana.ResultsA total of 1705 HIV-EU infants were included. Among these 645 (37.8%) were fed with iron-supplemented formula from birth. Severe anemia developed in 87 (5.1%) infants, and severe neutropenia in 164 (9.6%) infants. In an analysis stratified by infant feeding method, there were no significant differences in the risk of severe anemia by prophylactic cotrimoxazole exposure–risk difference, −0.69% (95% confidence interval [CI] −2.1 to 0.76%). Findings were similar in multivariable analysis, adjusted odds ratio (aOR) 0.35 (95% CI 0.07 to 1.65). There were also no significant differences observed for severe neutropenia by cotrimoxazole exposure, risk difference 2.0% (95% CI −1.3 to 5.2%) and aOR 0.80 (95% CI 0.33 to 1.93).ConclusionsSevere anemia and severe neutropenia were infrequent among HIV-exposed uninfected infants receiving cotrimoxazole from 1–6 months of age. Concerns regarding hematologic toxicity should not limit the use of prophylactic cotrimoxazole in HIV-exposed uninfected infants.ClinicalTrials.gov Registration NumbersNCT01086878 (http://clinicaltrials.gov/show/NCT01086878), NCT00197587 (http://clinicaltrials.gov/show/NCT00197587), and NCT00270296 (http://clinicaltrials.gov/show/NCT00270296).

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Time for new recommendations on cotrimoxazole prophylaxis for HIV-exposed infants in developing countries

Cited by 23 publications

References 7 publications

Health outcomes of HIV-exposed uninfected African infants

Health outcomes of HIV-exposed uninfected African infants

HIV-exposed infants

Cotrimoxazole Prophylaxis and Risk of Severe Anemia or Severe Neutropenia in HAART-Exposed, HIV-Uninfected Infants

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