Use of Cotrimoxazole Prophylactic treatment in HIV exposed children and its impact on malaria

Mbeye, Nyanyiwe Use of Cotrimoxazole Prophylactic treatment in HIV exposed children and its impact on malaria. PhD thesis, University of Liverpool.

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Abstract

The rapidly growing population of HIV exposed children entails widespread use of cotrimoxazole prophylactic treatment (CPT) to protect them from HIV opportunistic infections given their increased susceptibility compared to non-HIV exposed children. A number of studies have reported that CPT also provides protection against malaria but estimates of its effectiveness vary and there is little information on the impact of the prevalence of antifolate resistance mutations on its effect. Since daily CPT provides prophylaxis against malaria, it could modulate the development of malaria-specific immunity and increase the incidence of malaria after it is stopped (a rebound effect). Moreover, factors that influence CPT adherence in this group are not known. This thesis reviewed studies that examined the effect of CPT provided at the age of 6 weeks to 14 months on malaria incidence in children in Sub-Saharan Africa (systematic review) and investigated the incidence of malaria and other morbidities during and after CPT in the first two years of life in HIV exposed children in southern Malawi (cohort study). Lastly, CPT adherence was explored using narrative and grounded theory approaches (qualitative study). Results The systematic review included 3 Randomised Controlled Trials (RCTs) and four cohort studies fulfilling the eligibility criteria, with a total of 5,978 children (1,692 HIV exposed; 2,800 non-HIV exposed; 1,486 HIV-infected). Children on CPT were less likely to develop clinical malaria episodes than those without prophylaxis (combined Incidence Rate Ratio (IRR) = 0·37, 95% CI 0·21, 0·66) but there was substantial between-study heterogeneity (I-squared=94%, p

Item Type:	Thesis (PhD)
Additional Information:	Date: 2014-10 (completed)
Depositing User:	Symplectic Admin
Date Deposited:	26 Aug 2015 10:27
Last Modified:	17 Dec 2022 01:05
DOI:	10.17638/02003300
URI:	https://livrepository.liverpool.ac.uk/id/eprint/2003300