Cotrimoxazole Prophylaxis in HIV-Infected Pregnant Women and their Infants: Associations with Parasitemia, Common Illnesses and Birth Outcomes

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  • March 22, 2019
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  • Dow, Anna E.
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Cotrimoxazole prophylactic treatment (CPT) is recommended by the World Health Organization for prevention of opportunistic infections in adults and children. CPT is also recommended for HIV-exposed infants while they remain at risk of HIV acquisition through breastfeeding. The benefits of CPT have been well established in adults and HIV-infected children but limited information exists among HIV-infected pregnant women and HIVexposed, uninfected infants, including whether CPT offers protection against malaria. Using data from a longitudinal study of prevention of mother-to-child transmission of HIV, we examined the effect of CPT, initiated at six weeks of age, on adverse health outcomes during the first 36 weeks of life in HIV-exposed uninfected infants, and the effect of CPT in HIVinfected pregnant women on birth outcomes, incident malaria during pregnancy, and CD4 cell count at 24 weeks postpartum. Among HIV-exposed, uninfected infants, CPT was associated with fewer cases of incident malaria during the first 10 weeks of CPT exposure (hazard ratio (HR) 0.35, 95% confidence interval (CI): 0.21, 0.57), but not during the remaining 20 weeks of CPT use (HR 0.93, 95% CI: 0.67, 1.29). CPT did not offer protection against other serious illness, moderate or severe anemia, or underweight. Among HIV-infected pregnant women, CPT was not associated with a protective effect against malaria after adjustment for confounding (adjusted HR 0.66, 95% CI: 0.28, 1.52), when compared to women receiving intermittent preventive treatment during pregnancy with sulfadoxine-pyrimethamine. CPT was not associated with a protective effect in analyses of low birth weight or preterm birth. CPT was associated with a lower CD4 cell count at 24 weeks postpartum, among women receiving antiretrovirals (-77.6 cells/μL, 95% CI: -125.2, -30.1) and among women not receiving antiretrovirals (-33.7 cells/ μL, 95% CI: -8.8, -58.6). CPT appears to offer limited protection against malaria among HIV-exposed, uninfected infants. Compared to intermittent preventive treatment administered during the first two years of the study, CPT did not offer greater protection against malaria in HIV-infected pregnant women, or against low birth weight or preterm birth. CPT was associated with a lower CD4 cell count at 24 weeks compared to women not receiving CPT.
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  • ... in partial fulfillment of the requirements of the degree of Doctor of Philosophy in the Department of Epidemiology.
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  • Van Rie, Annelies
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