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. 2019 Nov 6;8(5):450-460.
doi: 10.1093/jpids/piy087.

Temporal Trends in Co-trimoxazole Use Among Children on Antiretroviral Therapy and the Impact of Co-trimoxazole on Mortality Rates in Children Without Severe Immunodeficiency

David C Boettiger  1 , Matthew G Law  1 , Annette H Sohn  2 , Mary-Ann Davies  3 , Kara Wools-Kaloustian  4 , Valeriane Leroy  5 , Marcel Yotebieng  6 , Michael Vinikoor  7   8 , Rachel Vreeman  4 , Madeleine Amorissani-Folquet  9 , Andrew Edmonds  10 , Geoffrey Fatti  11   12 , James Batte  13 , Lorna Renner  14 , Adebola Adedimeji  15 , Azar Kariminia  1 ; International Epidemiology Databases to Evaluate AIDS
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Temporal Trends in Co-trimoxazole Use Among Children on Antiretroviral Therapy and the Impact of Co-trimoxazole on Mortality Rates in Children Without Severe Immunodeficiency

David C Boettiger et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Co-trimoxazole is recommended for all children with human immunodeficiency virus. In this analysis, we evaluate trends in pediatric co-trimoxazole use and survival on co-trimoxazole in children using antiretroviral therapy (ART).

Methods: We used data collected between January 1, 2006, and March 31, 2016, from the International Epidemiology Databases to Evaluate AIDS. Logistic regression was used to evaluate factors associated with using co-trimoxazole at ART initiation. Competing risk regression was used to assess factors associated with death.

Results: A total of 54113 children were included in this study. The prevalence of co-trimoxazole use at ART initiation increased from 66.5% in 2006 to a peak of 85.6% in 2010 and then declined to 48.5% in 2015-2016. A similar trend was observed among children who started ART with severe immunodeficiency. After adjusting for year of ART initiation, younger age (odds ratio [OR], 1.18 for <1 vs 1 to <5 years of age [95% confidence interval (CI), 1.09-1.28]), lower height-for-age z score (OR, 1.15 for less than -3 vs greater than -2 [95% CI, 1.08-1.22]), anemia (OR, 1.08 [95% CI, 1.02-1.15]), severe immunodeficiency (OR, 1.25 [95% CI, 1.18-1.32]), and receiving care in East Africa (OR, 8.97 vs Southern Africa [95% CI, 8.17-9.85]) were associated with a high prevalence of co-trimoxazole use. Survival did not differ according to co-trimoxazole use in children without severe immunodeficiency (hazard ratio, 1.01 for nonusers versus users [95% CI, 0.77-1.34]).

Conclusions: Recent declines in co-trimoxazole use may not be linked to the current shift toward early ART initiation. Randomized trial data might be needed to establish the survival benefit of co-trimoxazole in children without severe immunodeficiency.

Keywords: HIV; antiretroviral therapy; children; co-trimoxazole.

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Figures

Figure 1.
Figure 1.
Trends in co-trimoxazole use and severe immunodeficiency at antiretroviral therapy (ART) initiation (N = 54113). *, No data available.
Figure 2.
Figure 2.
Cumulative incidence of death on antiretroviral therapy with or without concomitant co-trimoxazole use. Shaded regions represent the 95% confidence interval. Abbreviation: ART, antiretroviral therapy; CTX, co-trimoxazole.
See this image and copyright information in PMC

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References

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