The effect of cotrimoxazole prophylactic treatment on malaria, birth outcomes, and postpartum CD4 count in HIV-infected women

Anna Dow; Dumbani Kayira; Michael G Hudgens; Annelies Van Rie; Caroline C King; Sascha Ellington; Nelecy Chome; Athena Kourtis; Abigail Norris Turner; Zebrone Kacheche; Denise J Jamieson; Charles Chasela; Charles van der Horst

doi:10.1155/2013/340702

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The effect of cotrimoxazole prophylactic treatment on malaria, birth outcomes, and postpartum CD4 count in HIV-infected women

Journal article

Open access

Peer reviewed

The effect of cotrimoxazole prophylactic treatment on malaria, birth outcomes, and postpartum CD4 count in HIV-infected women

Anna Dow, Dumbani Kayira, Michael G Hudgens, Annelies Van Rie, Caroline C King, Sascha Ellington, Nelecy Chome, Athena Kourtis, Abigail Norris Turner, Zebrone Kacheche, …

Infectious diseases in obstetrics and gynecology, Vol.2013, pp.340702-8

2013

DOI: 10.1155/2013/340702

PMCID: PMC3865641

PMID: 24363547

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Abstract

Limited data exist on cotrimoxazole prophylactic treatment (CPT) in pregnant women, including protection against malaria versus standard intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp). Using observational data we examined the effect of CPT in HIV-infected pregnant women on malaria during pregnancy, low birth weight and preterm birth using proportional hazards, logistic, and log binomial regression, respectively. We used linear regression to assess effect of CPT on CD4 count. Data from 468 CPT-exposed and 768 CPT-unexposed women were analyzed. CPT was associated with protection against malaria versus IPTp (hazard ratio: 0.35, 95% Confidence Interval (CI): 0.20, 0.60). After adjustment for time period this effect was not statistically significant (adjusted hazard ratio: 0.66, 95% CI: 0.28, 1.52). Among women receiving and not receiving CPT, rates of low birth weight (7.1% versus 7.6%) and preterm birth (23.5% versus 23.6%) were similar. CPT was associated with lower CD4 counts 24 weeks postpartum in women receiving (-77.6 cells/ μ L, 95% CI: -125.2, -30.1) and not receiving antiretrovirals (-33.7 cells/ μ L, 95% CI: -58.6, -8.8). Compared to IPTp, CPT provided comparable protection against malaria in HIV-infected pregnant women and against preterm birth or low birth weight. Possible implications of CPT-associated lower CD4 postpartum warrant further examination.

Adult

AIDS-Related Opportunistic Infections - prevention & control

Antimalarials - therapeutic use

CD4 Lymphocyte Count

Female

HIV Infections - blood

Humans

Infant, Low Birth Weight

Malaria - prevention & control

Malawi

Pregnancy

Pregnancy Complications, Infectious - prevention & control

Pregnancy Outcome

Premature Birth

Regression Analysis

Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use

Young Adult

Details

Title: Subtitle: The effect of cotrimoxazole prophylactic treatment on malaria, birth outcomes, and postpartum CD4 count in HIV-infected women
Creators: Anna Dow - University of North Carolina at Chapel Hill
Dumbani Kayira - UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
Michael G Hudgens - University of North Carolina at Chapel Hill
Annelies Van Rie - University of North Carolina at Chapel Hill
Caroline C King - Centers for Disease Control and Prevention
Sascha Ellington - Centers for Disease Control and Prevention
Nelecy Chome - UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
Athena Kourtis - Centers for Disease Control and Prevention
Abigail Norris Turner - The Ohio State University
Zebrone Kacheche - UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
Denise J Jamieson - Centers for Disease Control and Prevention
Charles Chasela - University of the Witwatersrand
Charles van der Horst - University of North Carolina at Chapel Hill
Resource Type: Journal article
Publication Details: Infectious diseases in obstetrics and gynecology, Vol.2013, pp.340702-8
DOI: 10.1155/2013/340702
PMID: 24363547
PMCID: PMC3865641
NLM abbreviation: Infect Dis Obstet Gynecol
ISSN: 1064-7449
eISSN: 1098-0997
Grant note: 26-04 U48-DP000059-01 / NCCDPHP CDC HHS 22-09 U48-DP001944-01 / NCCDPHP CDC HHS 2-D43 TW01039-06 / FIC NIH HHS P30 AI050410 / NIAID NIH HHS U48 DP001944 / NCCDPHP CDC HHS 13-01 U48-CCU409660-09 / PHS HHS P30-AI50410 / NIAID NIH HHS U48 DP000059 / NCCDPHP CDC HHS
Language: English
Date published: 2013
Academic Unit: Obstetrics and Gynecology; VPMA - Administration
Record Identifier: 9984446069702771

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