Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire

a prospective cohort study

Aïda Mounkaila Harouna, Madeleine Amorissani-Folquet, François Tanoh Eboua, Sophie Desmonde, Sylvie N'Gbeche, Edmond Addi Aka, Kouakou Kouadio, Brou Kouacou, Karen Malateste, Clarisse Bosse-Amani, Patrick Ahuatchi Coffie, Valeriane Leroy, IeDEA paediatric West African Study Group, Morten Sodemann

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Resumé

BACKGROUND: Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and/or cotrimoxazole in Abidjan, Côte d'Ivoire.

METHODS: All HIV-infected children <16 years, followed-up in the IeDEA West-African paediatric cohort (pWADA) in Abidjan, were prospectively included from May to August 2012, the rainy season. Children presenting signs suggesting malaria had a thick blood smear and were classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model.

RESULTS: Overall, 1117 children were included, of whom 89 % were ART-treated and 67 % received cotrimoxazole. Overall, there were 51 malaria events occurring in 48 children: 28 confirmed and 23 probable; 94 % were uncomplicated malaria. The overall IR of malaria (confirmed and probable) was 18.3/100 CY (95 % CI: 13.3-23.4), varying from 4.2/100 CY (95 % CI: 1.1-7.3) in children on ART and cotrimoxazole to 57.3/100 CY (95 % CI: 7.1-107.6) for those receiving no treatment at all. In univariate analysis, age < 5 years was significantly associated with a 2-fold IR of malaria compared to age >10 years (incidence rate ratio [IRR] = 2.18, 95 % CI: 1.04-4.58). Adjusted for severe immunodeficiency, cotrimoxazole reduced significantly the IR of first malarial episode (adjusted IRR [aIRR] = 0.13, 95 % CI: 0.02-0.69 and aIRR = 0.05, 95 % CI:0.02-0.18 in those off and on ART respectively). Severe immunodeficiency increased significantly the malaria IR (aIRR = 4.03, 95 % CI: 1.55-10.47). When considering the IR of confirmed malaria only, this varied from 2.4/100 CY (95 % CI: 0.0-4.8) in children on ART and cotrimoxazole to 34.4/100 CY (95 % CI: 0.0-73.3) for those receiving no treatment at all. In adjusted analyses, the IR of malaria in children on both cotrimoxazole and ART was significantly reduced (aIRR = 0.05, 95 % CI: 0.01-0.24) compared to those receiving no treatment at all.

CONCLUSIONS: Cotrimoxazole prophylaxis was strongly protective against the incidence of malaria when associated with ART in HIV-infected children. Thus, these drugs should be provided as widely and durably as possible in all HIV-infected children <5 years of age.

OriginalsprogEngelsk
TidsskriftB M C Infectious Diseases
Vol/bind15
Sider (fra-til)317
ISSN1471-2334
DOI
StatusUdgivet - 2015

Fingeraftryk

Sulfamethoxazole Drug Combination Trimethoprim
Malaria
Cohort Studies
HIV
Prospective Studies
Incidence
Pharmaceutical Preparations

Citer dette

Harouna, Aïda Mounkaila ; Amorissani-Folquet, Madeleine ; Eboua, François Tanoh ; Desmonde, Sophie ; N'Gbeche, Sylvie ; Aka, Edmond Addi ; Kouadio, Kouakou ; Kouacou, Brou ; Malateste, Karen ; Bosse-Amani, Clarisse ; Ahuatchi Coffie, Patrick ; Leroy, Valeriane ; IeDEA paediatric West African Study Group ; Sodemann, Morten . / Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire : a prospective cohort study. I: B M C Infectious Diseases. 2015 ; Bind 15. s. 317.
@article{faf23bee04f847608c41973c92fd5a0b,
title = "Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, C{\^o}te d'Ivoire: a prospective cohort study",
abstract = "BACKGROUND: Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and/or cotrimoxazole in Abidjan, C{\^o}te d'Ivoire.METHODS: All HIV-infected children <16 years, followed-up in the IeDEA West-African paediatric cohort (pWADA) in Abidjan, were prospectively included from May to August 2012, the rainy season. Children presenting signs suggesting malaria had a thick blood smear and were classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model.RESULTS: Overall, 1117 children were included, of whom 89 {\%} were ART-treated and 67 {\%} received cotrimoxazole. Overall, there were 51 malaria events occurring in 48 children: 28 confirmed and 23 probable; 94 {\%} were uncomplicated malaria. The overall IR of malaria (confirmed and probable) was 18.3/100 CY (95 {\%} CI: 13.3-23.4), varying from 4.2/100 CY (95 {\%} CI: 1.1-7.3) in children on ART and cotrimoxazole to 57.3/100 CY (95 {\%} CI: 7.1-107.6) for those receiving no treatment at all. In univariate analysis, age < 5 years was significantly associated with a 2-fold IR of malaria compared to age >10 years (incidence rate ratio [IRR] = 2.18, 95 {\%} CI: 1.04-4.58). Adjusted for severe immunodeficiency, cotrimoxazole reduced significantly the IR of first malarial episode (adjusted IRR [aIRR] = 0.13, 95 {\%} CI: 0.02-0.69 and aIRR = 0.05, 95 {\%} CI:0.02-0.18 in those off and on ART respectively). Severe immunodeficiency increased significantly the malaria IR (aIRR = 4.03, 95 {\%} CI: 1.55-10.47). When considering the IR of confirmed malaria only, this varied from 2.4/100 CY (95 {\%} CI: 0.0-4.8) in children on ART and cotrimoxazole to 34.4/100 CY (95 {\%} CI: 0.0-73.3) for those receiving no treatment at all. In adjusted analyses, the IR of malaria in children on both cotrimoxazole and ART was significantly reduced (aIRR = 0.05, 95 {\%} CI: 0.01-0.24) compared to those receiving no treatment at all.CONCLUSIONS: Cotrimoxazole prophylaxis was strongly protective against the incidence of malaria when associated with ART in HIV-infected children. Thus, these drugs should be provided as widely and durably as possible in all HIV-infected children <5 years of age.",
author = "Harouna, {A{\"i}da Mounkaila} and Madeleine Amorissani-Folquet and Eboua, {Fran{\cc}ois Tanoh} and Sophie Desmonde and Sylvie N'Gbeche and Aka, {Edmond Addi} and Kouakou Kouadio and Brou Kouacou and Karen Malateste and Clarisse Bosse-Amani and {Ahuatchi Coffie}, Patrick and Valeriane Leroy and {IeDEA paediatric West African Study Group} and Morten Sodemann",
year = "2015",
doi = "10.1186/s12879-015-1009-6",
language = "English",
volume = "15",
pages = "317",
journal = "B M C Infectious Diseases",
issn = "1471-2334",
publisher = "BioMed Central",

}

Harouna, AM, Amorissani-Folquet, M, Eboua, FT, Desmonde, S, N'Gbeche, S, Aka, EA, Kouadio, K, Kouacou, B, Malateste, K, Bosse-Amani, C, Ahuatchi Coffie, P, Leroy, V, IeDEA paediatric West African Study Group & Sodemann, M 2015, 'Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire: a prospective cohort study', B M C Infectious Diseases, bind 15, s. 317. https://doi.org/10.1186/s12879-015-1009-6

Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire : a prospective cohort study. / Harouna, Aïda Mounkaila; Amorissani-Folquet, Madeleine; Eboua, François Tanoh; Desmonde, Sophie; N'Gbeche, Sylvie; Aka, Edmond Addi; Kouadio, Kouakou; Kouacou, Brou; Malateste, Karen; Bosse-Amani, Clarisse; Ahuatchi Coffie, Patrick; Leroy, Valeriane; IeDEA paediatric West African Study Group ; Sodemann, Morten .

I: B M C Infectious Diseases, Bind 15, 2015, s. 317.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire

T2 - a prospective cohort study

AU - Harouna, Aïda Mounkaila

AU - Amorissani-Folquet, Madeleine

AU - Eboua, François Tanoh

AU - Desmonde, Sophie

AU - N'Gbeche, Sylvie

AU - Aka, Edmond Addi

AU - Kouadio, Kouakou

AU - Kouacou, Brou

AU - Malateste, Karen

AU - Bosse-Amani, Clarisse

AU - Ahuatchi Coffie, Patrick

AU - Leroy, Valeriane

AU - IeDEA paediatric West African Study Group

AU - Sodemann, Morten

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and/or cotrimoxazole in Abidjan, Côte d'Ivoire.METHODS: All HIV-infected children <16 years, followed-up in the IeDEA West-African paediatric cohort (pWADA) in Abidjan, were prospectively included from May to August 2012, the rainy season. Children presenting signs suggesting malaria had a thick blood smear and were classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model.RESULTS: Overall, 1117 children were included, of whom 89 % were ART-treated and 67 % received cotrimoxazole. Overall, there were 51 malaria events occurring in 48 children: 28 confirmed and 23 probable; 94 % were uncomplicated malaria. The overall IR of malaria (confirmed and probable) was 18.3/100 CY (95 % CI: 13.3-23.4), varying from 4.2/100 CY (95 % CI: 1.1-7.3) in children on ART and cotrimoxazole to 57.3/100 CY (95 % CI: 7.1-107.6) for those receiving no treatment at all. In univariate analysis, age < 5 years was significantly associated with a 2-fold IR of malaria compared to age >10 years (incidence rate ratio [IRR] = 2.18, 95 % CI: 1.04-4.58). Adjusted for severe immunodeficiency, cotrimoxazole reduced significantly the IR of first malarial episode (adjusted IRR [aIRR] = 0.13, 95 % CI: 0.02-0.69 and aIRR = 0.05, 95 % CI:0.02-0.18 in those off and on ART respectively). Severe immunodeficiency increased significantly the malaria IR (aIRR = 4.03, 95 % CI: 1.55-10.47). When considering the IR of confirmed malaria only, this varied from 2.4/100 CY (95 % CI: 0.0-4.8) in children on ART and cotrimoxazole to 34.4/100 CY (95 % CI: 0.0-73.3) for those receiving no treatment at all. In adjusted analyses, the IR of malaria in children on both cotrimoxazole and ART was significantly reduced (aIRR = 0.05, 95 % CI: 0.01-0.24) compared to those receiving no treatment at all.CONCLUSIONS: Cotrimoxazole prophylaxis was strongly protective against the incidence of malaria when associated with ART in HIV-infected children. Thus, these drugs should be provided as widely and durably as possible in all HIV-infected children <5 years of age.

AB - BACKGROUND: Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and/or cotrimoxazole in Abidjan, Côte d'Ivoire.METHODS: All HIV-infected children <16 years, followed-up in the IeDEA West-African paediatric cohort (pWADA) in Abidjan, were prospectively included from May to August 2012, the rainy season. Children presenting signs suggesting malaria had a thick blood smear and were classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model.RESULTS: Overall, 1117 children were included, of whom 89 % were ART-treated and 67 % received cotrimoxazole. Overall, there were 51 malaria events occurring in 48 children: 28 confirmed and 23 probable; 94 % were uncomplicated malaria. The overall IR of malaria (confirmed and probable) was 18.3/100 CY (95 % CI: 13.3-23.4), varying from 4.2/100 CY (95 % CI: 1.1-7.3) in children on ART and cotrimoxazole to 57.3/100 CY (95 % CI: 7.1-107.6) for those receiving no treatment at all. In univariate analysis, age < 5 years was significantly associated with a 2-fold IR of malaria compared to age >10 years (incidence rate ratio [IRR] = 2.18, 95 % CI: 1.04-4.58). Adjusted for severe immunodeficiency, cotrimoxazole reduced significantly the IR of first malarial episode (adjusted IRR [aIRR] = 0.13, 95 % CI: 0.02-0.69 and aIRR = 0.05, 95 % CI:0.02-0.18 in those off and on ART respectively). Severe immunodeficiency increased significantly the malaria IR (aIRR = 4.03, 95 % CI: 1.55-10.47). When considering the IR of confirmed malaria only, this varied from 2.4/100 CY (95 % CI: 0.0-4.8) in children on ART and cotrimoxazole to 34.4/100 CY (95 % CI: 0.0-73.3) for those receiving no treatment at all. In adjusted analyses, the IR of malaria in children on both cotrimoxazole and ART was significantly reduced (aIRR = 0.05, 95 % CI: 0.01-0.24) compared to those receiving no treatment at all.CONCLUSIONS: Cotrimoxazole prophylaxis was strongly protective against the incidence of malaria when associated with ART in HIV-infected children. Thus, these drugs should be provided as widely and durably as possible in all HIV-infected children <5 years of age.

U2 - 10.1186/s12879-015-1009-6

DO - 10.1186/s12879-015-1009-6

M3 - Journal article

VL - 15

SP - 317

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

SN - 1471-2334

ER -