Positive Effect of Cotrimoxazole Prophylaxis in HIV-infected Children
Blandina Theophil*1,2, Blandina Theophil*1,2, G Kinabo1,2, G Kinabo1,2, M Swai1, J Shao1,2, J Shao1,2, J Mchele3, M Henderikxm4, B Mulder4, E Houpt3, J Tolboom5, W Schimana1,6, and W Schimana1,6
1Kilimanjaro Christian Med Ctr, Moshi, Tanzania; 2Kilimanjaro Christian Med Coll, Tumaini Univ, Moshi, Tanzania; 3KCMC Biotech Lab and the Virginia Univ; 4Lab of Med Microbio and Publ Hlth, Enschede, The Nertherlands; 5St Raboud Univ, Nimegen; and 6Elizabeth Glaser Pediatric AIDS Fndn, Dar es Salaam, Tanzania
Background: Cotrimoxazole (CTX) has been used for the
prophylaxis of Pneumocystis
pneumonia (PCP) and other bacterial and
protozoa infection in HIV-infected individuals and was shown to reduce
morbidity and mortality in people living with HIV/AIDS (PLWHA). Our
aim was to evaluate the effect of CTX in HIV-infected children enrolled into
HIV care and treatment.
Method: We conducted a
cross sectional, hospital-based study, between September 2005 and March 2006.
Over this 6 month study period, 120 HIV-infected children between 5 months and 13
years of age were enrolled. The presence of diarrhea, Cryptosporidium,
use of CTX, and nutritional status were assessed and if CD4 percentage was available,
the results were recorded. Cryptosporidium
in stool was detected using modified acid-fast staining and subsets of samples
were also tested with polymerase chain reaction (PCR) or ELISA methods.
Results: Of 120 children
enrolled, the mean age was 79 months with a range of 6 to 165 months; 70
(58.3%) were male; and 78 (65%) reported receiving CTX prophylaxis. Diarrhea was reported in 37 of 120 (30.8%),
but only 9 (11.5%) of the patients on CTX prophylaxis had diarrhea. CTX use was
significantly associated with diarrhea reduction (ρ –value <0.001, CI 0.04
to 0.24). Cryptosporidium infection was
detected in 13 of 120 (10.8 %) patients, of whom 6 had diarrhea. Cryptosporidium infection was detected
in only 3 of 78 (3.9%) children on CTX prophylaxis compared to 10 of 42 (23.8%)
not on CTX (ρ -value
0.001, CI 0.03 to 0.50). Of 100 patients with CD4 percentage available, 59
(59.0%) had CD4 <15%, of whom, 10 (17.0%) had Cryptosporidium.
Low CD4 percentage count was significantly associated with presence of Cryptosporidium in children not
on CTX prophylaxis (ρ value < 0.001). Death occurred in 13 of 120
children; 12 (92.3%) were not on CTX prophylaxis. CTX use was significantly
associated with a reduced mortality (ρ <0.001). Presence of diarrhea (p = 0.16), presence of Cryptosporidium (p = 0.35), severe dehydration (p = 0.001), and underweight (p = 0.031) were predictors of
Conclusions: CTX prophylaxis is associated with a reduced
risk of diarrhea and mortality in HIV-infected children. Apart from its
prophylactic effect on PCP and toxoplasmosis, CTX may also prevent other opportunistic
infections, including Cryptosporidium
infection or diarrhea. Therefore, all HIV-infected or exposed children should
receive CTX prophylaxis.