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

• Published in: Clinical infectious diseases Vol. 65; no. 4; pp. 575 - 580
• Main Authors: Davis, Nicole L., Wiener, Jeffrey, Juliano, Jonathan J., Adair, Linda, Chasela, Charles S., Kayira, Dumbani, Hudgens, Michael G., van der Horst, Charles, Jamieson, Denise J., Kourtis, Athena P.
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 15.08.2017
• Subjects: Adolescent; Adult; Age; and Commentaries; Antibiotics; Antimalarials - therapeutic use; Antiretroviral drugs; Antiviral agents; ARTICLES AND COMMENTARIES; Asymptomatic Infections; Breast feeding; Confidence intervals; Cotrimoxazole; Diarrhea; Exposure; Female; Hazards; Health risks; HIV; HIV Infections; Human immunodeficiency virus; Humans; Infant; Infants; Infectious diseases; Malaria; Malaria - drug therapy; Malaria - epidemiology; Malawi - epidemiology; Male; Middle Aged; Morbidity; Mortality; Nutrition; Parasitemia; Parasitemia - drug therapy; Parasitemia - epidemiology; Parasites; Prophylaxis; Reduction; Risk assessment; Spots; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Vector-borne diseases; Viruses; Weaning; Young Adult; Malawi; infectious morbidity; HIV; co-trimoxazole; infant; malaria
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cix367

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.