Journal article
Effects of concurrent exposure to antiretrovirals and cotrimoxazole prophylaxis among HIV-exposed, uninfected infants
AIDS (London), Vol.31(18), pp.2455-2463
11/28/2017
DOI: 10.1097/QAD.0000000000001641
PMCID: PMC6059368
PMID: 28926409
Abstract
Background: Given the potential of cotrimoxazole preventive therapy (CPT) to prevent bacterial and malarial infections in HIV-exposed, uninfected (HEU) infants, it is important to evaluate the effects of its concurrent use with antiretroviral agents that have overlapping toxicity profiles.
Methods: We used data from the Breastfeeding, Antiretrovirals, and Nutrition study (2004-2010) to evaluate the association of CPT and antiretrovirals with hematologic measures (hemoglobin, neutrophil, and alanine aminotransferase levels) from 6 to 48 weeks of age in 2006 HEU infants in Lilongwe, Malawi. Hazards of severe outcomes (anemia, neutropenia, and elevated alanine aminotransferase), as defined by the National Institutes of Health, were compared using Cox regression models, according to time-varying CPT (implemented June 2006), antiretroviral treatment arm (maternal triple antiretroviral, infant nevirapine, or none during 6 months of breastfeeding), and their interaction. The effects of these treatments on hemoglobin, neutrophil, and alanine aminotransferase levels were assessed using linear mixed models.
Results: In Cox models, CPT was associated with an increase in severe neutropenia [hazard ratio 1.97 (1.01, 3.86)] and a decrease in severe anemia (hazard ratio 0.65 (0.48, 0.88)]. Interactions between CPT and antiretroviral treatment were not significant. By 36 weeks, there was a significant association of CPT with increased hemoglobin levels regardless of antiretroviral drug exposure.
Conclusions: In addition to expected associations with increased hazard of severe neutropenia and decreased neutrophil count, CPT was associated with reduced hazard of severe anemia and higher infant blood hemoglobin. This provides further support for CPT use in HEU infants in malaria-endemic resource-limited settings where anemia is prevalent. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
Details
- Title: Subtitle
- Effects of concurrent exposure to antiretrovirals and cotrimoxazole prophylaxis among HIV-exposed, uninfected infants
- Creators
- Alexander C. Ewing - Centers for Disease Control and PreventionCaroline C. King - Centers for Disease Control and PreventionJeffrey B. Wiener - Centers for Disease Control and PreventionCharles S. Chasela - University of the WitwatersrandMichael G. Hudgens - University of North Carolina at Chapel HillDebbie Kamwendo - UNC Project, Lilongwe, MalawiGerald Tegha - UNC Project, Lilongwe, MalawiMina C. Hosseinipour - University of North Carolina at Chapel HillDenise J. Jamieson - Centers for Disease Control and PreventionCharles Van der Horst - University of North Carolina at Chapel HillAthena P. Kourtis - Centers for Disease Control and Prevention
- Resource Type
- Journal article
- Publication Details
- AIDS (London), Vol.31(18), pp.2455-2463
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/QAD.0000000000001641
- PMID
- 28926409
- PMCID
- PMC6059368
- ISSN
- 0269-9370
- eISSN
- 1473-5571
- Number of pages
- 9
- Grant note
- R24 TW007988 / National Institutes of Health Fogarty International Programs [Scholars and Fellows Program] Elizabeth Glaser Pediatric AIDS Foundation R24 HD050924 / Carolina Population Center U.S. Agency for International Development; United States Agency for International Development (USAID) SIP 13-01 U48-CCU409660-09; SIP 26-04 U48-DP000059-01; SIP 22-09 U48-DP001944-01 / Prevention Research Centers Special Interest Project of the Centers for Disease Control and Prevention Johnson Johnson; Johnson & Johnson; Johnson & Johnson USA National Institutes of Health Fogarty International Programs [American Recovery and Reinvestment Act] P30-AI50410 / University of North Carolina Center for AIDS Research OPP53107 / Bill and Melinda Gates Foundation; Bill & Melinda Gates Foundation World Food Program National Institute of Allergy and Infectious Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Allergy & Infectious Diseases (NIAID) Malawi Ministry of Health and Population United Nations Children's Fund D43 TW001039 / National Institutes of Health Fogarty International Programs [AIDS International Training and Research Program]
- Language
- English
- Date published
- 11/28/2017
- Academic Unit
- Obstetrics and Gynecology; VPMA - Administration
- Record Identifier
- 9984446415502771
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