%0 Journal Article
%T The Effect of Cotrimoxazole Prophylactic Treatment on Malaria, Birth Outcomes, and Postpartum CD4 Count in HIV-Infected Women
%A Anna Dow
%A Dumbani Kayira
%A Michael G. Hudgens
%A Annelies Van Rie
%A Caroline C. King
%A Sascha Ellington
%A Nelecy Chome
%A Athena Kourtis
%A Abigail Norris Turner
%A Zebrone Kacheche
%A Denise J. Jamieson
%A Charles Chasela
%A Charles van der Horst
%J Infectious Diseases in Obstetrics and Gynecology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/340702
%X Background. Limited data exist on cotrimoxazole prophylactic treatment (CPT) in pregnant women, including protection against malaria versus standard intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp). Methods. 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. Results. 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/¦ÌL, 95% CI: £¿125.2, £¿30.1) and not receiving antiretrovirals (£¿33.7£¿cells/¦ÌL, 95% CI: £¿58.6, £¿8.8). Conclusions. 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. 1. Introduction Cotrimoxazole prophylaxis has been shown to reduce morbidity and mortality in HIV-infected adults and children [1¨C5]. The World Health Organization (WHO) guidelines issued in 2006 recommend daily cotrimoxazole prophylactic treatment (CPT) for HIV-infected adults and HIV-infected pregnant women with CD4 cell counts of less than 350£¿cells/¦ÌL or WHO clinical stage III or IV [6]. The WHO guidelines advised adapting the CD4-based CPT eligibility cut points based on availability of CD4 testing and country-specific resources. Data on CPT in HIV-infected pregnant women are scarce, though there is some evidence suggesting that CPT may reduce the risk of poor birth outcomes in women with CD4 cell counts of less than 200£¿cells/¦ÌL in addition to reducing morbidity and mortality due to opportunistic infections [7]. CPT in HIV-infected adults has been associated with reduced malaria incidence [1, 3, 8]. HIV-infected pregnant women may have greater benefit from malaria prophylaxis, as these women experience more peripheral and placental malaria compared with HIV-uninfected pregnant women [9]. Due to similarities between cotrimoxazole
%U http://www.hindawi.com/journals/idog/2013/340702/