Abstract
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.
Original language | English (US) |
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Pages (from-to) | 575-580 |
Number of pages | 6 |
Journal | Clinical Infectious Diseases |
Volume | 65 |
Issue number | 4 |
DOIs | |
State | Published - Aug 15 2017 |
Funding
The BAN study was supported by grants from the Prevention Research Centers Special Interest Project of the CDC (SIP 13-01 U48-CCU409660-09, SIP 26-04 U48-DP000059-01, and SIP 22-09 U48-DP001944-01); the National Institute of Allergy and Infectious Diseases (R03 AI100694, R56 AI091547, and U01 AI068632); the University of North Carolina Center for AIDS Research (P30 AI050410); the National Institutes of Health (NIH) Fogarty AIDS International Training and Research Program (DHHS/NIH/FIC 2-D43 TW01039-06); the Fogarty International Clinical Research Scholars Program (R24 TW007988); the American Recovery and Reinvestment Act); and the Infectious Disease Epidemiology Training Grant (5T32 AI070114). The Call to Action prevention of mother-to-child HIV transmission program was supported by the Elizabeth Glaser Pediatric AIDS Foundation, the United Nations Children's Fund, the World Food Program, the Malawi Ministry of Health and Population, Johnson & Johnson, and the US Agency for International Development.
Keywords
- HIV
- co-trimoxazole
- infant
- infectious morbidity
- malaria
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases