Impact of daily cotrimoxazole on clinical malaria and asymptomatic parasitemias in HIV-exposed, uninfected infants

Nicole L Davis; Eric J Barnett; William C Miller; Anna Dow; Charles S Chasela; Michael G Hudgens; Dumbani Kayira; Gerald Tegha; Sascha R Ellington; Athena P Kourtis; Charles van der Horst; Denise J Jamieson; Jonathan J Juliano

doi:10.1093/cid/civ309

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Impact of daily cotrimoxazole on clinical malaria and asymptomatic parasitemias in HIV-exposed, uninfected infants

Journal article

Open access

Peer reviewed

Impact of daily cotrimoxazole on clinical malaria and asymptomatic parasitemias in HIV-exposed, uninfected infants

Nicole L Davis, Eric J Barnett, William C Miller, Anna Dow, Charles S Chasela, Michael G Hudgens, Dumbani Kayira, Gerald Tegha, Sascha R Ellington, Athena P Kourtis, …

Clinical infectious diseases, Vol.61(3), pp.368-374

08/01/2015

DOI: 10.1093/cid/civ309

PMCID: PMC4542924

PMID: 25900173

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Abstract

Cotrimoxazole preventive therapy (CPT) is recommended for all human immunodeficiency virus (HIV)-exposed infants to avoid opportunistic infections. Cotrimoxazole has antimalarial effects and appears to reduce clinical malaria infections, but the impact on asymptomatic malaria infections is unknown. We conducted an observational cohort study using data and dried blood spots (DBSs) from the Breastfeeding, Antiretrovirals and Nutrition study to evaluate the impact of CPT on malaria infection during peak malaria season in Lilongwe, Malawi. We compared malaria incidence 1 year before and after CPT implementation (292 and 682 CPT-unexposed and CPT-exposed infants, respectively), including only infants who remained HIV negative by 36 weeks of age. Malaria was defined as clinical, asymptomatic (using DBSs at 12, 24, and 36 weeks), or a composite outcome of clinical or asymptomatic. Linear and binomial regression with generalized estimating equations were used to estimate the association between CPT and malaria. Differences in characteristics of parasitemias and drug resistance polymorphisms by CPT status were also assessed in the asymptomatic infections. CPT was associated with a 70% (95% confidence interval, 53%-81%) relative reduction in the risk of asymptomatic infection between 6 and 36 weeks of age. CPT appeared to provide temporary protection against clinical malaria and more sustained protection against asymptomatic infections, with no difference in parasitemia characteristics. CPT appears to reduce overall malaria infections, with more prolonged impacts on asymptomatic infections. Asymptomatic infections are potentially important reservoirs for malaria transmission. Therefore, CPT prophylaxis may have important individual and public health benefits.

Antimalarials - administration & dosage

Antimalarials - pharmacology

Antimalarials - therapeutic use

Asymptomatic Infections

Drug Resistance

Female

HIV Infections

Humans

Infant

Malaria - drug therapy

Malaria - epidemiology

Malaria - parasitology

Malawi - epidemiology

Male

Parasitemia - drug therapy

Parasitemia - epidemiology

Parasitemia - parasitology

Plasmodium falciparum - drug effects

Plasmodium falciparum - genetics

Random Allocation

Trimethoprim, Sulfamethoxazole Drug Combination - administration & dosage

Trimethoprim, Sulfamethoxazole Drug Combination - pharmacology

Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use

Details

Title: Subtitle: Impact of daily cotrimoxazole on clinical malaria and asymptomatic parasitemias in HIV-exposed, uninfected infants
Creators: Nicole L Davis - University of North Carolina at Chapel Hill
Eric J Barnett - University of North Carolina at Chapel Hill
William C Miller - University of North Carolina at Chapel Hill
Anna Dow - Department of Epidemiology, Gillings School of Global Public Health
Charles S Chasela - University of the Witwatersrand
Michael G Hudgens - University of North Carolina at Chapel Hill
Dumbani Kayira - University of North Carolina, UNC Project, Lilongwe, Malawi
Gerald Tegha - University of North Carolina, UNC Project, Lilongwe, Malawi
Sascha R Ellington - Centers for Disease Control and Prevention
Athena P Kourtis - Centers for Disease Control and Prevention
Charles van der Horst - University of North Carolina at Chapel Hill
Denise J Jamieson - Centers for Disease Control and Prevention
Jonathan J Juliano - University of North Carolina at Chapel Hill
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.61(3), pp.368-374
DOI: 10.1093/cid/civ309
PMID: 25900173
PMCID: PMC4542924
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Grant note: U48-CCU409660-09 / PHS HHS D43 TW001039 / FIC NIH HHS R03 AI100694 / NIAID NIH HHS P30-AI50410 / NIAID NIH HHS U48 DP000059 / NCCDPHP CDC HHS U48-DP000059-01 / NCCDPHP CDC HHS U48-DP001944-01 / NCCDPHP CDC HHS 5T32AI070114 / NIAID NIH HHS T32 AI070114 / NIAID NIH HHS R24 TW007988 / FIC NIH HHS 2-D43 TW01039-06 / FIC NIH HHS P30 AI050410 / NIAID NIH HHS U48 DP001944 / NCCDPHP CDC HHS R03AI100694-A1 / NIAID NIH HHS
Language: English
Date published: 08/01/2015
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446264302771

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