Impact of cotrimoxazole prophylaxis on the health of breast-fed, HIV-exposed, HIV-negative infants in a resource-limited setting
Department Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa; Programme of Biostatistics Research Ethics and Medical Law, School of Family and Public Health, University of KwaZulu-Natal, Durban, South Africa
WHO guidelines recommend cotrimoxazole prophylaxis (CTXP) in all HIV-exposed negative infants who are still breastfeeding. This is based on the evidence of efficacy in HIV-infected infants, but there is no evidence of benefit in HIV-negative, breast-fed infants. We assessed the impact of CTXP on diarrhoeal and respiratory morbidity in breast-fed, HIV-exposed negative infants in a community programme. CTXP for more than 60 days showed no consistent evidence of benefit for incidence of lower respiratory tract infection [incidence rate ratio (IRR) 0.71, 95% confidence interval (CI) 0.39-1.26; P=0.241] but an increased incidence of diarrhoea (IRR=1.38, 95% CI 0.98-1.94; P=0.065). The guidelines should be reconsidered by conducting a randomized control trial. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.
cotrimoxazole; article; breast feeding; diarrhea; drug efficacy; human; Human immunodeficiency virus infection; infant; lower respiratory tract infection; major clinical study; morbidity; priority journal; prophylaxis; socioeconomics; vertical transmission; Breast Feeding; Female; HIV Infections; HIV-1; Humans; Infant; Infectious Disease Transmission, Vertical; Male; Odds Ratio; Pregnancy; Risk Factors; Rural Population; South Africa; Trimethoprim-Sulfamethoxazole Combination