Early Height and Weight Changes in Children Using Cotrimoxazole Prophylaxis With Antiretroviral Therapy

Boettiger DC 1 , Muktiarti D 2 , Kurniati N 2 , Truong KH 3 , Saghayam S 4 , Ly PS 5 Show all authors , Hansudewechakul R 6 , Van Nguyen L 7 , Do VC 8 , Sudjaritruk T 9 , Lumbiganon P 10 , Chokephaibulkit K 11 , Bunupuradah T 12 , Nik Yusoff NK 13 , Wati DK 14 , Mohd Razali KA 15 , Fong MS 16 , Nallusamy RA 17 , Sohn AH 18 , Kariminia A 1 , Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) Pediatric HIV Observational Database

Affiliations 

  • 1 The Kirby Institute, University of New South Wales, Sydney, Australia
  • 2 Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
  • 3 Children's Hospital 1, Ho Chi Minh City, Vietnam
  • 4 Y.R. Gaitonde Center for AIDS Research and Education Medical Centre, Chennai, India
  • 5 National Centre for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
  • 6 Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
  • 7 National Hospital of Pediatrics, Hanoi
  • 8 Children's Hospital 2, Ho Chi Minh City, Vietnam
  • 9 Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai
  • 10 Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen
  • 11 Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
  • 12 HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
  • 13 Hospital Raja Perempuan Zainab II, Kelantan, Malaysia
  • 14 Sanglah Hospital, Udayana University, Bali, Indonesia
  • 15 Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur
  • 16 Hospital Likas, Kota Kinabalu
  • 17 Penang Hospital, Penang, Malaysia
  • 18 TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand
Clin Infect Dis, 2016 Nov 01;63(9):1236-1244.
PMID: 27470239

Abstract

BACKGROUND:  The growth benefits of cotrimoxazole during early antiretroviral therapy (ART) are not well characterized.

METHODS:  Individuals enrolled in the Therapeutics Research, Education, and AIDS Training in Asia Pediatric HIV Observational Database were included if they started ART at ages 1 month-14 years and had both height and weight measurements available at ART initiation (baseline). Generalized estimating equations were used to identify factors associated with change in height-for-age z-score (HAZ), follow-up HAZ ≥ -2, change in weight-for-age z-score (WAZ), and follow-up WAZ ≥ -2.

RESULTS:  A total of 3217 children were eligible for analysis. The adjusted mean change in HAZ among cotrimoxazole and non-cotrimoxazole users did not differ significantly over the first 24 months of ART. In children who were stunted (HAZ < -2) at baseline, cotrimoxazole use was not associated with a follow-up HAZ ≥ -2. The adjusted mean change in WAZ among children with a baseline CD4 percentage (CD4%) >25% became significantly different between cotrimoxazole and non-cotrimoxazole users after 6 months of ART and remained significant after 24 months (overall P < .01). Similar changes in WAZ were observed in those with a baseline CD4% between 10% and 24% (overall P < .01). Cotrimoxazole use was not associated with a significant difference in follow-up WAZ in children with a baseline CD4% <10%. In those underweight (WAZ < -2) at baseline, cotrimoxazole use was associated with a follow-up WAZ ≥ -2 (adjusted odds ratio, 1.70 vs not using cotrimoxazole [95% confidence interval, 1.28-2.25], P < .01). This association was driven by children with a baseline CD4% ≥10%.

CONCLUSIONS:  Cotrimoxazole use is associated with benefits to WAZ but not HAZ during early ART in Asian children.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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