Effect of cotrimoxazole prophylaxis on malaria occurrence in HIV infected patients on antiretroviral therapy in sub-Saharan Africa.


Kasirye, R; Baisley, K; Munderi, P; Grosskurth, H; (2015) Effect of cotrimoxazole prophylaxis on malaria occurrence in HIV infected patients on antiretroviral therapy in sub-Saharan Africa. Tropical medicine & international health . ISSN 1360-2276 DOI: 10.1111/tmi.12463

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Abstract

To systematically review the evidence on the effect of cotrimoxazole (CTX) on malaria in HIV positive individuals on antiretroviral (ART). Web of Science, Pubmed and Medline, Embase, Global Health and Cochrane Library databases were searched using terms for malaria, HIV and CTX. Studies meeting the inclusion criteria were reviewed and assessed for bias and confounding. Six studies (in Uganda, Kenya, Malawi, Zambia and Zimbabwe) had relevant data on the effect of CTX on malaria in patients on ART: 4 were observational cohort studies (OCS) and 2 were randomized controlled trials (RCTs); 2 were in children and 1 in women only. Samples sizes ranged from 265 to 2200 patients. Four studies compared patients on ART and CTX with patients on ART alone; 2 (RCT) found a significant increase in smear-positive malaria on ART alone: (IRR 32.5 CI=8.6-275.0 and HR 2.21CI=1.5-3.3) and 2 (OCS) reported fewer parasitaemia episodes on CTX and ART (OR 0.85 CI=0.65-1.11 and 3.6% versus 2.4% of samples P=0.14). One OCS found a 76% (95% CI=63-84%) versus 83% (95%CI=74-89%) reduction in malaria incidence in children on CTX and ART versus on CTX only, when both were compared with HIV negative children. The other reported a 64% reduction in malaria incidence after adding ART to CTX (RR=0.36, 95%CI=0.18-0.74). The 2 RCTs were unblinded. Only 1 study reported adherence to CTX and ART, and only 2 controlled for baseline CD4 count. Few studies have investigated the effect of CTX on malaria in patients on ART. Their findings suggest that CTX is protective against malaria even among patients on ART. This article is protected by copyright. All rights reserved.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Tropical Epidemiology Group
PubMed ID: 25600931
Web of Science ID: 352534600002
URI: http://researchonline.lshtm.ac.uk/id/eprint/2055204

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