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Mussa A, Powis KM, Lockman S, Ajibola G, Morroni C, Smeaton L, Mmalane M, Makhema J, Shapiro RL. Prolonged Cotrimoxazole Prophylaxis Has No Impact on Child Growth in the First Two Years of Life: Findings from a Randomized Controlled Trial in Botswana. J Pediatr 2022; 246:266-270.e2. [PMID: 35351531 PMCID: PMC9233016 DOI: 10.1016/j.jpeds.2022.03.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 03/07/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
We investigated the impact of prolonged cotrimoxazole prophylaxis on growth in 2848 HIV-exposed uninfected children enrolled in the Mpepu study, a randomized, placebo-controlled trial in Botswana. No significant differences in mean weight-for-age, length-for-age, or weight-for-length z scores between placebo and cotrimoxazole arms were observed overall through 18 months.
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Affiliation(s)
- Aamirah Mussa
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.
| | - Kathleen M. Powis
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;,Division of Internal Medicine, Massachusetts General Hospital, Boston, MA;,Division of Pediatrics, Massachusetts General Hospital, Boston, MA;,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA;,Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA
| | | | - Chelsea Morroni
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;,MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura Smeaton
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Joseph Makhema
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Roger L. Shapiro
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana;,Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA
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Kerebeh G, Ayalew Y, Kefale D, Chanie ES, Misganaw NM, Feleke DG, Kassaw A, Tigabu A, Bantie B, Tamirat M, Mengesha T, Azmeraw M, Endalamaw A. Incidence of anemia and predictors among Human Immunodeficiency Virus-infected children on antiretroviral therapy at public health facilities of Bahir Dar City, Northwest Ethiopia: multicenter retrospective follow up study. BMC Pediatr 2022; 22:115. [PMID: 35241033 PMCID: PMC8892717 DOI: 10.1186/s12887-022-03168-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background Anemia is one of the common hematological problems among HIV-infected children. It impairs physical functioning, affects the quality of life, increases HIV progression, and decreases survival of HIV-infected children. In Ethiopia, limited studies were conducted on the incidence and predictors of anemia among HIV-infected children on antiretroviral therapy (ART). Therefore, this study aims to assess the incidence of anemia and predictors among HIV- infected children on ART at public health facilities of Bahir Dar City, Northwest Ethiopia. Methods An institution-based retrospective follow-up study was conducted among 403 HIV- infected children who have followed at ART clinics in public health facilities of Bahir Dar City from 2010 to 2020. A simple random sampling technique was employed to select the study units. Data was entered using Epi-data version 4.6 and analyzed using STATA 14.0. Cox proportional hazard model assumption was checked graphically and by scaled Schoenfeld residual test. Bivariable Cox-proportional hazards regression model was employed for each explanatory variable to check the association with the outcome variable. Variables with a p-value of < 0.2 in the bivariable analysis were candidates to the multivariable proportional hazard model. Cox proportional hazards model was used at a 5% level of significance to identify predictors of anemia. Results The overall follow up time was 1587 person–years. The overall incidence density of anemia was 6.87 with 95% confidence interval (CI) = (5.60, 8.16) per 100 person-years. The independent predictors show an association were child age from 0.25 to 5 years adjusted hazard ratio (AHR) = (1.83; 95% CI = 1.22, 2.77), World health organization clinical stage III and IV (AHR = 1.80; 95% CI = 1.22, 2.67), being underweight (AHR = 1.5; 95% CI = 1.01, 2.26), having fair/poor adherence to anti-retroviral therapy (AHR = 1.75; 95% CI = 1.08, 2.85) and zidovidine based anti -retroviral therapy regimen (AHR = 1.72; 95% CI = 1.12, 2.64). Conclusion The overall incidence rate of anemia was high compared to other country reports. Age, clinical, and ART-related variables provoked the incidence of anemia. Therefore, a need to emphasize the younger age group, prevent and manage opportunistic infections of WHO clinical stage III and IV, and select and monitor appropriate ART regimen types.
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Affiliation(s)
- Gashaw Kerebeh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia.
| | - Yeneneh Ayalew
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Natnael Moges Misganaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Dejen Getaneh Feleke
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, P.O. Box: 272, Debre Tabor, Ethiopia
| | - Agimasie Tigabu
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mahlet Tamirat
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Teshale Mengesha
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
| | - Molla Azmeraw
- Department of Nursing, School of Health Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.,School of Public Health, the University of Queensland, Brisbane, Australia
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3
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Waltmann A, McQuade ETR, Chinkhumba J, Operario DJ, Mzembe E, Itoh M, Kayange M, Puerto-Meredith SM, Mathanga DP, Juliano JJ, Carroll I, Bartelt LA, Gutman JR, Meshnick SR. The positive effect of malaria IPTp-SP on birthweight is mediated by gestational weight gain but modifiable by maternal carriage of enteric pathogens. EBioMedicine 2022; 77:103871. [PMID: 35217408 PMCID: PMC8866062 DOI: 10.1016/j.ebiom.2022.103871] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Poor pregnancy and birth outcomes are common in sub-Saharan Africa and have complex aetiologies. Sulfadoxine-pyrimethamine (SP), given for intermittent preventive therapy of malaria in pregnancy (IPTp), is one of few existing interventions that improves outcomes of both mother and baby despite widespread SP-resistant malaria. Compelling evidence exists that malaria-independent pathways contribute to this protective effect, but the exact sources of non anti-malarial protection remained unknown. We hypothesized that the beneficial effect of SP on birthweight is mediated by SP activity on maternal factors, including increased gestational weight gain and antibiotic activity on pathogens in the maternal gut. METHODS Expectant mothers from a larger randomized control trial comparing the efficacy of IPTp-SP to IPTp with dihydroartemisinin-piperaquine (DP) were also enrolled in this sub-study study at their first antenatal care visit before commencement of IPTp (n = 105). Participants were followed monthly until delivery. Weights and mid-to-upper-arm circumferences (MUAC) were recorded. Monthly stool samples were collected and screened for five Escherichia coli pathotypes, Shigella spp., Vibrio cholerae, Salmonella, Campylobacter coli/jejuni, and three protozoa (Giardia spp., Entameba histolytica, and Cryptosporidium spp.) using previously validated molecular assays. FINDINGS IPTp-SP vs. IPTP-DP was associated with higher maternal gestational weight gain (GWG) and nutritional indicators (MUAC and body-mass index, BMI). GWG was found to be a mediator of the birthweight and IPTp-SP relationship, as the birthweight of SP infants, but not DP infants, varied according to maternal GWG. The burden of maternal enteric infections was high. The three most commonly observed pathogens were enteroaggregative E. coli (EAEC), atypical enteropathogenic E.coli/enterohaemorrhagic E. coli (aEPEC/EHEC), and typical enteropathogenic E.coli (tEPEC). We found that SP reduced the prevalence of EAEC in a dose-dependent manner. After 3 or more doses, SP-recipients were 90% less likely to be infected with EAEC compared to DP-recipients (ORadj = 0.07, CI95 = 0.12, 0.39, p = 0.002). Compared to DP, this coincided with higher maternal gestational weight gain (GWG) and nutritional indicators (MUAC and body-mass index, BMI). The beneficial effect of SP on maternal GWG, MUAC and BMI, was lower if SP mothers had detectable EAEC, aEPEC/EHEC, tEPEC, and LT-ETEC at baseline. Maternal EAEC and tEPEC at baseline associated with lower birthweight for babies of both SP mothers and DP mothers. When comparing IPTp regimens, the positive effect of SP on birthweight compared to DP was only observed for infants of women who did not test positive for EAEC at baseline (adjusted mean birthweight difference SP vs. DP = 156.0 g, CI95 = -18.0 g, 336.9 g, p = 0.087), though confidence intervals crossed the null. INTERPRETATION Our findings indicate that in pregnant Malawian women, IPTp-SP vs. IPTp-DP is consistently associated with higher MUAC, BMI, and GWG following the WHO-recommended regimen of at least 3 doses, but carriage of maternal gut pathogens before initiation of IPTp lessens this effect. Because GWG was a mediator of the association between birthweight and SP, we show that SP's previously proven positive effect on birthweight is by promoting maternal weight gain. Overall, our results present one plausible pathway SP exerts malaria-independent protection against poor birth outcomes in the context of its waning antimalarial activity and warrants further investigation. FUNDING A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.
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Affiliation(s)
- Andreea Waltmann
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | | | - Jobiba Chinkhumba
- Malaria Alert Centre (MAC), University of Malawi College of Medicine, Blantyre, Malawi
| | - Darwin J Operario
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia, VA, USA
| | - Enala Mzembe
- Malaria Alert Centre (MAC), University of Malawi College of Medicine, Blantyre, Malawi
| | - Megumi Itoh
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Don P Mathanga
- Malaria Alert Centre (MAC), University of Malawi College of Medicine, Blantyre, Malawi
| | - Jonathan J Juliano
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Ian Carroll
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Luther A Bartelt
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven R Meshnick
- Institute for Global Health and Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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4
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Arzika AM, Maliki R, Ali MM, Alio MK, Abdou A, Cotter SY, Varnado NE, Lebas E, Cook C, Oldenburg CE, O’Brien KS, Callahan EK, Bailey RL, West SK, Porco TC, Lietman TM, Keenan JD. Effect of Mass Azithromycin Distributions on Childhood Growth in Niger: A Cluster-Randomized Trial. JAMA Netw Open 2021; 4:e2139351. [PMID: 34967883 PMCID: PMC8719241 DOI: 10.1001/jamanetworkopen.2021.39351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Mass azithromycin distributions may decrease childhood mortality, although the causal pathway is unclear. The potential for antibiotics to function as growth promoters may explain some of the mortality benefit. OBJECTIVE To investigate whether biannual mass azithromycin distributions are associated with increased childhood growth. DESIGN, SETTING, AND PARTICIPANTS This cluster-randomized trial was performed from December 2014 until March 2020 among 30 rural communities in Boboye and Loga departments in Niger, Africa, with populations from 200 to 2000 individuals. Communities were randomized in a 1:1 ratio to biannual mass distributions of azithromycin or placebo for children ages 1 to 59 months. Participants, field-workers, and study personnel were masked to treatment allocation. Height and weight changes from baseline to follow-up at 4 years were compared between groups. Data were analyzed from June through November 2021. INTERVENTIONS Participants received azithromycin at 20 mg/kg using height-based approximation or by weight for children unable to stand every 6 months at the participants' households. Placebo contained the vehicle of the azithromycin suspension. MAIN OUTCOMES AND MEASURES Longitudinal anthropometric assessments were performed on a random sample of children before the first treatment and then annually for 5 years. Height and weight were the prespecified primary outcomes. RESULTS Among 3936 children enrolled from 30 communities, baseline characteristics were similar between 1299 children in the azithromycin group and 2637 children in the placebo group (mean 48.2% [95% CI, 45.5% to 50.8%] girls vs 48.0% [95% CI, 45.7% to 50.3%] girls; mean age, 30.8 months [95% CI, 29.5 to 32.0 months] vs 30.6 months [95% CI, 29.2 to 31.6 months]). Baseline anthropometric assessments were performed among 2230 children, including 985 children in the azithromycin group and 1245 children in the placebo group, of whom follow-up measurements were available for 789 children (80.1%) and 1063 children (85.4%), respectively. At the prespecified 4-year follow-up visit, children in the azithromycin group gained a mean 6.7 cm (95% CI, 6.5 to 6.8 cm) in height and 1.7 kg (95% CI, 1.7 to 1.8 kg) in weight per year and children in the placebo group gained a mean 6.6 cm (95% CI, 6.4 to 6.7 cm) in height and 1.7 kg (95% CI, 1.7 to 1.8 kg) in weight per year. Height at 4 years was not statistically significantly different between groups when adjusted for baseline height (0.08 cm [95% CI, -0.12 to 0.28 cm] greater in the azithromycin group; P = .45), and neither was weight when adjusted for height and baseline weight (0.02 kg [95% CI, -0.10 to 0.06 kg] less in the azithromycin group; P = .64). However, among children in the shortest quartile of baseline height, azithromycin was associated with a 0.4 cm (95% CI, 0.1 to 0.7 cm) increase in height compared with placebo. CONCLUSIONS AND RELEVANCE This study did not find evidence of an association between mass azithromycin distributions and childhood growth, although subgroup analysis suggested some benefit for the shortest children. These findings suggest that the mortality benefit of mass azithromycin distributions is unlikely to be due solely to growth promotion. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02048007.
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Affiliation(s)
- Ahmed M. Arzika
- Carter Center, Niamey, Niger
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Ramatou Maliki
- Carter Center, Niamey, Niger
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | | | - Mankara K. Alio
- Centre de Recherche et Interventions en Santé Publique, Birni N’Gaoure, Niger
| | - Amza Abdou
- Programme National de Santé Oculaire, Niamey, Niger
| | - Sun Y. Cotter
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Nicole E. Varnado
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Catherine Cook
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Catherine E. Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Kieran S. O’Brien
- Francis I. Proctor Foundation, University of California, San Francisco
| | | | - Robin L. Bailey
- London School of Hygiene and Tropical Medicine, London, England
| | - Sheila K. West
- Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland
| | - Travis C. Porco
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
| | - Thomas M. Lietman
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
- Department of Epidemiology & Biostatistics, University of California, San Francisco, California
- Institute for Global Health Sciences, University of California, San Francisco
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco
- Department of Ophthalmology, University of California, San Francisco
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5
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Ramblière L, Guillemot D, Delarocque-Astagneau E, Huynh BT. Impact of mass and systematic antibiotic administration on antibiotic resistance in low- and middle-income countries? A systematic review. Int J Antimicrob Agents 2021; 58:106364. [PMID: 34044108 DOI: 10.1016/j.ijantimicag.2021.106364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/09/2021] [Accepted: 05/15/2021] [Indexed: 11/29/2022]
Abstract
Antibiotic consumption is a key driver of antimicrobial resistance (AR), particularly in low- and middle-income countries (LMICs) where risk factors for AR emergence and spread are prevalent. However, the potential contribution of mass drug administration (MDA) and systematic drug administration (SDA) of antibiotics to AR spread is unknown. We conducted a systematic review to provide an overview of MDA/SDA in LMICs, including indications, antibiotics used and, if investigated, levels of AR over time. This systematic review is reported in accordance with the PRISMA statement. Of 2438 identified articles, 63 were reviewed: indications for MDA/SDA were various, and targeted populations were particularly vulnerable, including pregnant women, children, human immunodeficiency virus (HIV)-infected populations, and communities in outbreak settings. Available data suggest that MDA/SDA may lead to a significant increase in AR, especially following azithromycin administration. However, only 40% of studies evaluated AR. Integrative approaches that evaluate AR in addition to clinical outcomes are needed to understand the consequences of MDA/SDA implementation, combined with standardised AR surveillance for timely detection of AR emergence.
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Affiliation(s)
- Lison Ramblière
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015, Paris, France.
| | - Didier Guillemot
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015, Paris, France; AP-HP Paris Saclay, Public Health, Medical Information, Clinical Research, F-94276, Le Kremlin-Bicêtre, France
| | - Elisabeth Delarocque-Astagneau
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; AP-HP Paris Saclay, Public Health, Medical Information, Clinical Research, F-94276, Le Kremlin-Bicêtre, France
| | - Bich-Tram Huynh
- Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective Evasion and Pharmacoepidemiology Team, F- 78180, Montigny-Le-Bretonneux, France; Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), F-75015, Paris, France
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6
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Noble CCA, Sturgeon JP, Bwakura-Dangarembizi M, Kelly P, Amadi B, Prendergast AJ. Postdischarge interventions for children hospitalized with severe acute malnutrition: a systematic review and meta-analysis. Am J Clin Nutr 2021; 113:574-585. [PMID: 33517377 PMCID: PMC7948836 DOI: 10.1093/ajcn/nqaa359] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/06/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Children hospitalized with severe acute malnutrition (SAM) have poor long-term outcomes following discharge, with high rates of mortality, morbidity, and impaired neurodevelopment. There is currently minimal guidance on how to support children with SAM following discharge from inpatient treatment. OBJECTIVES This systematic review and meta-analysis aimed to examine whether postdischarge interventions can improve outcomes in children recovering from complicated SAM. METHODS Systematic searches of 4 databases were undertaken to identify studies of interventions delivered completely or partially after hospital discharge in children aged 6-59 mo, following inpatient treatment of SAM. The main outcome of interest was mortality. Random-effects meta-analysis was undertaken where ≥2 studies were sufficiently similar in intervention and outcome. RESULTS Ten studies fulfilled the inclusion criteria, recruiting 39-1781 participants in 7 countries between 1975 and 2015. Studies evaluated provision of zinc (2 studies), probiotics or synbiotics (2 studies), antibiotics (1 study), pancreatic enzymes (1 study), and psychosocial stimulation (4 studies). Six studies had unclear or high risk of bias in ≥2 domains. Compared with standard care, pancreatic enzyme supplementation reduced inpatient mortality (37.8% compared with 18.6%, P < 0.05). In meta-analysis there was some evidence that prebiotics or synbiotics reduced mortality (RR: 0.72; 95% CI: 0.51, 1.00; P = 0.049). Psychosocial stimulation reduced mortality in meta-analysis of the 2 trials reporting deaths (RR: 0.36; 95% CI: 0.15, 0.87), and improved neurodevelopmental scores in ≥1 domain in all studies. There was no evidence that zinc reduced mortality in the single study reporting deaths. Antibiotics reduced infectious morbidity but did not reduce mortality. CONCLUSIONS Several biological and psychosocial interventions show promise in improving outcomes in children following hospitalization for SAM and require further exploration in larger randomized mortality trials. This study was registered with PROSPERO as CRD42018111342 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=111342).
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Affiliation(s)
- Christie C A Noble
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jonathan P Sturgeon
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Mutsa Bwakura-Dangarembizi
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Paul Kelly
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Beatrice Amadi
- Tropical Gastroenterology and Nutrition Group, University of Zambia, Lusaka, Zambia
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London, United Kingdom
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
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7
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Geleta ML, Solomon FB, Tufa EG, Sadamo FE, Dake SK. Predictors of Anemia Among HIV-Infected Children on Antiretroviral Therapy in Wolaita Zone, South Ethiopia: A Facility-Based Cross-Sectional Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:13-19. [PMID: 33447087 PMCID: PMC7802890 DOI: 10.2147/hiv.s282845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/12/2020] [Indexed: 11/23/2022]
Abstract
Purpose Anemia is a global public health problem, and the majority of human immunodeficiency virus (HIV)-positive people become anemic at some point in the course of the disease. We lack adequate evidence on the magnitude of anemia among children on highly active antiretroviral therapy in Ethiopia and particularly in South Ethiopia. Thus, this study aimed at determining the proportion and associated factors of anemia among children on highly active antiretroviral therapy in Wolaita zone, South Ethiopia. Patients and Methods A facility-based cross-sectional study was conducted from November to December 2018 on 256 children from 6 months to 14 years of age who were on antiretroviral therapy. Data were collected through an interview with caregivers and review of medical records. CD4+ cell count was analyzed using FACS Calibur, and hemoglobin level was measured with a Hem cue 301 analyzer. Stool samples were examined for the presence of intestinal parasites by direct wet mount technique. Data analyzed with Stata version 14.0 were conveyed in mean and standard deviation of the mean, median and inter-quartile range. Multivariate analysis was carried out to identify independent predictors of the outcome variable. Adjusted odds ratio with 95% confidence interval was reported. Results The proportion of anemia was found to be 38.8%. Co-trimoxazole prophylaxis (AOR=0.45; 95% CI: 0.21, 0.95), caregivers not receiving nutritional counseling (AOR=0.90; 95% CI: 0.01, 0.98) and presence of intestinal parasites (AOR=3.10; 95% CI: 1.39, 6.88) were associated with anemia. Conclusion The proportion of anemia found in this study is a moderate public health problem. Health education programs in antiretroviral therapy clinics should be targeted at appropriate dietary practice, and appropriate hand washing and other hygienic practices to prevent intestinal parasitic infections. Co-trimoxazole prophylaxis should be given to all eligible children based on the recommendation.
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Affiliation(s)
- Mesay Lema Geleta
- College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Fithamlak Bisetegn Solomon
- Department of Medical Laboratory, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Efrata Girma Tufa
- Department of Reproductive Health and Nutrition, School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Fekadu Elias Sadamo
- Department of Reproductive Health and Nutrition, School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Samson Kastro Dake
- Department of Reproductive Health and Nutrition, School of Public Health, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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8
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Dirajlal-Fargo S, El-Kamari V, Weiner L, Shan L, Sattar A, Kulkarni M, Funderburg N, Nazzinda R, Karungi C, Kityo C, Musiime V, McComsey GA. Altered Intestinal Permeability and Fungal Translocation in Ugandan Children With Human Immunodeficiency Virus. Clin Infect Dis 2021; 70:2413-2422. [PMID: 31260509 DOI: 10.1093/cid/ciz561] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Children with perinatally acquired human immunodeficiency virus (HIV; PHIVs) face a lifelong cumulative exposure to HIV and antiretroviral therapy (ART). The relationship between gut integrity, microbial translocation, and inflammation in PHIV is poorly understood. METHODS This is a cross-sectional study in 57 PHIVs, 59 HIV-exposed but uninfected children, and 56 HIV-unexposed and -uninfected children aged 2-10 years old in Uganda. PHIVs were on stable ART with HIV-1 RNA <400 copies/mL. We measured markers of systemic inflammation, monocyte activation, and gut integrity. Kruskal-Wallis tests were used to compare markers by group and the Spearman correlation was used to assess correlations between biomarkers. RESULTS The mean age of all participants was 7 years and 55% were girls. Among PHIVs, the mean CD4 % was 34%, 93% had a viral load ≤20 copies/mL, and 79% were on a nonnucleoside reverse transcriptase inhibitor regimen. Soluble cluster of differentiation 14 (sCD14), beta-D-glucan (BDG), and zonulin were higher in the PHIV group (P ≤ .01). Intestinal fatty acid binding protein (I-FABP) and lipopolysaccharide binding protein (LBP) did not differ between groups (P > .05). Among PHIVs who were breastfed, levels of sCD163 and interleukin 6 (IL6) were higher than levels in PHIV who were not breastfed (P < .05). Additionally, in PHIVs with a history of breastfeeding, sCD14, BDG, LBP, zonulin, and I-FABP correlated with several markers of systemic inflammation, including high-sensitivity C-reactive protein, IL6, d-dimer, and systemic tumor necrosis factor receptors I and II (P ≤ .05). CONCLUSIONS Despite viral suppression, PHIVs have evidence of altered gut permeability and fungal translocation. Intestinal damage and the resultant bacterial and fungal translocations in PHIVs may play a role in the persistent inflammation that leads to many end-organ diseases in adults.Despite viral suppression, children with perinatally acquired human immunodeficiency virus (HIV) in Uganda have evidence of alterations in intestinal permeability and fungal translocation, compared to HIV-exposed but uninfected and HIV-unexposed children, which may play a role in HIV-associated chronic inflammation.
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Affiliation(s)
- Sahera Dirajlal-Fargo
- University Hospitals Cleveland Medical Center, Columbus.,Rainbow Babies and Children's Hospital, Columbus.,Case Western Reserve University, Columbus
| | | | | | | | | | - Manjusha Kulkarni
- Ohio State University School of Health and Rehabilitation Sciences, Columbus
| | - Nicholas Funderburg
- Ohio State University School of Health and Rehabilitation Sciences, Columbus
| | | | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Victor Musiime
- Joint Clinical Research Centre, Kampala, Uganda.,Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Grace A McComsey
- University Hospitals Cleveland Medical Center, Columbus.,Rainbow Babies and Children's Hospital, Columbus.,Case Western Reserve University, Columbus
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9
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Techane MA, Anlay DZ, Tesfaye E, Agegnehu CD. <p>Incidence and Predictors of Anemia Among Children on Antiretroviral Therapy at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2007–2017: A Retrospective Follow-Up Study</p>. HIV AIDS (Auckl) 2020; 12:951-962. [PMID: 33364852 PMCID: PMC7751604 DOI: 10.2147/hiv.s282675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 11/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Anemia is the most common hematological abnormality among children on antiretroviral therapy. In Ethiopia, as far as our search, there are no studies done on the incidence and predictors of anemia among children on antiretroviral therapy. This study aimed to assess the incidence and predictors of anemia among children on antiretroviral therapy, attending antiretroviral therapy care at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, from 2007 to 2017. Methods A retrospective follow-up study was conducted among 391 children on antiretroviral therapy. Mean survival time for children to be anemia free was estimated. A Log rank test was used to compare survival curves among different independent variables. The Cox regression model was used. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was calculated. P-value ≤0.05 was considered as statically significant. Results The overall incidence rate of anemia was 10.5 (95% confidence interval (8.6, 12.8)) per 100 child-year. Being severe-immunosuppressed (AHR=2.9, 95% CI: 1.23–6.77), undernutrition (AHR =2.7, 95% CI: 1.5–5), taking zidovudine-based ART regimen (AHR =4, 95% CI: 1.23–12.9), and tuberculosis (AHR =2.1, 95% CI: 1.4–3.3) were independent predictors of anemia among children. Conclusion In this study, the incidence rate of anemia among children on antiretroviral therapy was found to be high. Tuberculosis, zidovudine-based drugs, severe immunosuppression, and undernutrition have remained statically significant predictors of anemia among children on antiretroviral therapy. Children with HIV were the most vulnerable group for anemia, especially in developing countries. Therefore, improving their nutritional status and considering other predictors of anemia were very important for children to reduce the incidence of anemia among children with HIV.
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Affiliation(s)
- Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Degefaye Zelalem Anlay
- Community Health Nursing Unit, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eleni Tesfaye
- Community Health Nursing Unit, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, Ethiopia
- Correspondence: Chilot Desta Agegnehu School of Nursing, College of Medicine and Health Sciences and Comprehensive Specialized Hospital, University of Gondar, Gondar, EthiopiaTel +251 918627403 Email
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10
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Duffy C, Kenga DB, Gebretsadik T, Maússe FE, Manjate A, Zaqueu E, Fernando HF, Green AF, Sacarlal J, Moon TD. Multiple Concurrent Illnesses Associated with Anemia in HIV-Infected and HIV-Exposed Uninfected Children Aged 6-59 Months, Hospitalized in Mozambique. Am J Trop Med Hyg 2020; 102:605-612. [PMID: 31933456 PMCID: PMC7056436 DOI: 10.4269/ajtmh.19-0424] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Anemia is an increasingly recognized problem in sub-Saharan Africa. To determine the magnitude, severity, and associated factors of anemia among hospitalized children aged 6–59 months, HIV-infected and HIV-exposed uninfected children (a child born to a known HIV-infected mother) with a documented fever or history of fever within the prior 24 hours of hospital admission (N = 413) were included in this analysis. Of 413 children enrolled, 364 (88%) were anemic, with 53% classified as mild anemia (hemoglobin [Hb] 7–9.9 g/dL). The most common diagnoses associated with hospital admission included acute respiratory illness (51%), malnutrition (47%), gastroenteritis/diarrhea (25%), malaria (17%), and bacteremia (13%). A diagnosis of malaria was associated with a decrease in Hb by 1.54 g/dL (P < 0.001). In HIV-infected patients, malaria was associated with a similar decrease in Hb (1.47 g/dL), whereas a dual diagnosis of bacteremia and malaria was associated with a decrease in Hb of 4.12 g/dL (P < 0.001). No difference was seen in Hb for patients on antiretroviral therapy versus those who were not. A diagnosis of bacteremia had a roughly 4-fold increased relative odds of death during hospitalization (adjusted odds ratio = 3.97; 95% CI: 1.61, 9.78; P = 0.003). The etiology of anemia in high-burden malaria, HIV, tuberculosis, and poor nutrition countries is multifactorial, and multiple etiologies may be contributing to one’s anemia at any given time. Algorithms used by physician and nonphysician clinicians in Mozambique should incorporate integrated and non–disease specific approaches to pediatric anemia management and should include improved access to blood culture.
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Affiliation(s)
- Caitlyn Duffy
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Darlenne B Kenga
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fabião E Maússe
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Alice Manjate
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | | | - Ann F Green
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jahit Sacarlal
- Department of Microbiology, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | - Troy D Moon
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
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11
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Bourke CD, Gough EK, Pimundu G, Shonhai A, Berejena C, Terry L, Baumard L, Choudhry N, Karmali Y, Bwakura-Dangarembizi M, Musiime V, Lutaakome J, Kekitiinwa A, Mutasa K, Szubert AJ, Spyer MJ, Deayton JR, Glass M, Geum HM, Pardieu C, Gibb DM, Klein N, Edens TJ, Walker AS, Manges AR, Prendergast AJ. Cotrimoxazole reduces systemic inflammation in HIV infection by altering the gut microbiome and immune activation. Sci Transl Med 2020; 11:11/486/eaav0537. [PMID: 30944164 DOI: 10.1126/scitranslmed.aav0537] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 11/21/2018] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Abstract
Long-term cotrimoxazole prophylaxis reduces mortality and morbidity in HIV infection, but the mechanisms underlying these clinical benefits are unclear. Here, we investigate the impact of cotrimoxazole on systemic inflammation, an independent driver of HIV mortality. In HIV-positive Ugandan and Zimbabwean children receiving antiretroviral therapy, we show that plasma inflammatory markers were lower after randomization to continue (n = 144) versus stop (n = 149) cotrimoxazole. This was not explained by clinical illness, HIV progression, or nutritional status. Because subclinical enteropathogen carriage and enteropathy can drive systemic inflammation, we explored cotrimoxazole effects on the gut microbiome and intestinal inflammatory biomarkers. Although global microbiome composition was unchanged, viridans group Streptococci and streptococcal mevalonate pathway enzymes were lower among children continuing (n = 36) versus stopping (n = 36) cotrimoxazole. These changes were associated with lower fecal myeloperoxidase. To isolate direct effects of cotrimoxazole on immune activation from antibiotic effects, we established in vitro models of systemic and intestinal inflammation. In vitro cotrimoxazole had modest but consistent inhibitory effects on proinflammatory cytokine production by blood leukocytes from HIV-positive (n = 16) and HIV-negative (n = 8) UK adults and reduced IL-8 production by gut epithelial cell lines. Collectively we demonstrate that cotrimoxazole reduces systemic and intestinal inflammation both indirectly via antibiotic effects on the microbiome and directly by blunting immune and epithelial cell activation. Synergy between these pathways may explain the clinical benefits of cotrimoxazole despite high antimicrobial resistance, providing further rationale for extending coverage among people living with HIV in sub-Saharan Africa.
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Affiliation(s)
- Claire D Bourke
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK.
| | - Ethan K Gough
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | | | - Annie Shonhai
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Chipo Berejena
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Louise Terry
- Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Lucas Baumard
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Naheed Choudhry
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Yusuf Karmali
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | | | - Victor Musiime
- Joint Clinical Research Centre, Kampala, Uganda.,College of Health Sciences, Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - Joseph Lutaakome
- Uganda Virus Research Institute/MRC Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Adeodata Kekitiinwa
- Baylor College of Medicine Children's Foundation-Uganda, Mulago Hospital, Kampala, Uganda
| | - Kuda Mutasa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | | | - Moira J Spyer
- MRC Clinical Trials Unit at University College London, London WC1V 6LJ, UK
| | - Jane R Deayton
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK.,Royal London Hospital, Barts Health NHS Trust, London E1 1BB, UK
| | - Magdalena Glass
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Hyun Min Geum
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Claire Pardieu
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK
| | - Diana M Gibb
- MRC Clinical Trials Unit at University College London, London WC1V 6LJ, UK
| | - Nigel Klein
- UCL Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Thaddeus J Edens
- Devil's Staircase Consulting, West Vancouver, British Columbia V7T 1V7, Canada
| | - A Sarah Walker
- MRC Clinical Trials Unit at University College London, London WC1V 6LJ, UK
| | - Amee R Manges
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Andrew J Prendergast
- Blizard Institute, Queen Mary University of London, London E1 2AT, UK.,Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.,MRC Clinical Trials Unit at University College London, London WC1V 6LJ, UK
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12
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Linear growth in preschool children treated with mass azithromycin distributions for trachoma: A cluster-randomized trial. PLoS Negl Trop Dis 2019; 13:e0007442. [PMID: 31166952 PMCID: PMC6550377 DOI: 10.1371/journal.pntd.0007442] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 05/07/2019] [Indexed: 12/21/2022] Open
Abstract
Background Mass azithromycin distributions have been shown to reduce mortality among pre-school children in sub-Saharan Africa. It is unclear what mediates this mortality reduction, but one possibility is that antibiotics function as growth promoters for young children. Methods and findings 24 rural Ethiopian communities that had received biannual mass azithromycin distributions over the previous four years were enrolled in a parallel-group, cluster-randomized trial. Communities were randomized in a 1:1 ratio to either continuation of biannual oral azithromycin (20mg/kg for children, 1 g for adults) or to no programmatic antibiotics over the 36 months of the study period. All community members 6 months and older were eligible for the intervention. The primary outcome was ocular chlamydia; height and weight were measured as secondary outcomes on children less than 60 months of age at months 12 and 36. Study participants were not masked; anthropometrists were not informed of the treatment allocation. Anthropometric measurements were collected for 282 children aged 0–36 months at the month 12 assessment and 455 children aged 0–59 months at the month 36 assessment, including 207 children who had measurements at both time points. After adjusting for age and sex, children were slightly but not significantly taller in the biannually treated communities (84.0 cm, 95%CI 83.2–84.8, in the azithromycin-treated communities vs. 83.7 cm, 95%CI 82.9–84.5, in the untreated communities; mean difference 0.31 cm, 95%CI -0.85 to 1.47, P = 0.60). No adverse events were reported. Conclusions Periodic mass azithromycin distributions for trachoma did not demonstrate a strong impact on childhood growth. Trial registration The TANA II trial was registered on clinicaltrials.gov #NCT01202331. Mass distribution of a single dose of the broad-spectrum antibiotic azithromycin twice per year to pre-school children in Sub-Saharan Africa has been shown to reduce childhood mortality. The mechanism by which azithromycin reduces mortality is currently not clear, especially since the antibiotic is not targeted to sick children but rather given to all children in the community whether or not they have an infectious disease. In this study, we report the height and weight of children enrolled in a trial in Ethiopia in which communities were randomized either to twice annual mass azithromycin distributions for blinding trachoma or to no treatments. After accounting for age and sex, children from azithromycin-treated communities were on average slightly taller at the 12- and 36-month study visits than those from untreated communities, but the difference was not statistically significant.
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13
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Sié A, Dah C, Ouermi L, Tapsoba C, Zabre P, Bärnighausen T, Lebas E, Arzika AM, Snyder BM, Porco TC, Lietman TM, Keenan JD, Oldenburg CE. Effect of Antibiotics on Short-Term Growth among Children in Burkina Faso: A Randomized Trial. Am J Trop Med Hyg 2018; 99:789-796. [PMID: 30014828 DOI: 10.4269/ajtmh.18-0342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Antibiotics improve both weight and height gain in randomized trials of preschool children with preexisting morbidity. Here, we assess the effect of a short course of three different antibiotics (amoxicillin, azithromycin, and cotrimoxazole) on short-term linear and ponderal growth in a population-based sample of preschool children in rural Burkina Faso. We randomized households with at least two children in the Nouna district, Burkina Faso, to a 5-day course of amoxicillin, azithromycin, cotrimoxazole, or placebo. Within each antibiotic-randomized household, one child was randomly assigned to receive the antibiotic and the other to receive the placebo. Weight and height measurements were taken at baseline and 30 days following the last study medication dose. Weight-for-height Z (WHZ), height-for-age Z (HAZ), and weight-for-age Z (WAZ) scoreswere calculated based on the 2006 World Health Organization standards. Of the 124 households and 248 children enrolled, 229 had anthropometry measurements at 1 month and were analyzed. Children randomized to amoxicillin gained significantly more weight compared with both the placebo household (mean difference 317 g, 95% confidence interval [CI]: 115-519 g) and placebo sibling (mean difference 315 g, 95% CI: 147-482 g) controls. Growth velocity in g/kg/day, and WHZ and WAZ scores were higher in amoxicillin-treated children compared with placebo households and siblings. There were no differences in weight gain in children randomized to azithromycin or cotrimoxazole compared with placebo households or placebo siblings. There were no differences in height gain or HAZ across any of the study arms. Amoxicillin may have short-term growth-promoting effects in healthy children.
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Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | | | - Blake M Snyder
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Thomas M Lietman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Jeremy D Keenan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Catherine E Oldenburg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
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14
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High Burden of Morbidity and Mortality but Not Growth Failure in Infants Exposed to but Uninfected with Human Immunodeficiency Virus in Tanzania. J Pediatr 2017; 180:191-199.e2. [PMID: 27829511 PMCID: PMC5183465 DOI: 10.1016/j.jpeds.2016.09.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare health and growth outcomes in children infected with HIV, children exposed to but uninfected with HIV, and children unexposed to HIV. STUDY DESIGN Our cohort included 3554 Tanzanian children enrolled in 2 trials of micronutrient supplementation. Among infants born to mothers infected with HIV, 264 were infected with HIV and 2088 were exposed to but uninfected at 6 weeks of age. An additional 1202 infants were unexposed to HIV. Infants were followed until 18 months of age, death, or loss to follow-up. Morbidity and growth were assessed at monthly nurse visits. RESULTS Compared with unexposed infants, hazard ratios (95% CI) for all-cause mortality in infants infected with HIV and infants who were exposed to but uninfected with HIV were 28.99 (14.83-56.66) and 2.79 (1.41-5.53), respectively, after adjusting for demographic and nutritional covariates. Compared with infants unexposed to HIV, infants infected with HIV also had a significantly greater risk of all measured morbidities, while infants who were exposed to but uninfected with HIV were significantly more likely to suffer from cough, fever, unscheduled outpatient visits, and hospitalizations. Infants infected with HIV also were more likely to experience stunting, wasting, and underweight at baseline and during follow-up. Infants exposed to but uninfected with HIV were more likely to be underweight at baseline (adjusted relative risk, 2.05; 95% CI, 1.45-2.89), but on average, experienced slower declines in height-for-age z-score, weight-for-age z-score, and weight-for-height z-score as well as a lower rate of stunting over follow-up, compared with unexposed infants. CONCLUSION In addition to preventing and treating HIV infection in infants, prevention-of-mother-to-child-transmission of HIV and child health services should also target children exposed to but uninfected with HIV to improve health outcomes in this vulnerable population. TRIAL REGISTRATION Clinicaltrials.gov: NCT00197730 and NCT00421668.
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15
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Bate A, Kimbi HK, Lum E, Lehman LG, Onyoh EF, Ndip LM, Njabi CM, Tonga C, B Wempnje G, Ndip RN, Bessong PO. Malaria infection and anaemia in HIV-infected children in Mutengene, Southwest Cameroon: a cross sectional study. BMC Infect Dis 2016; 16:523. [PMID: 27682438 PMCID: PMC5041210 DOI: 10.1186/s12879-016-1853-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is one of the leading causes of morbidity and mortality in children and HIV infection as well as other factors may worsen the situation. This study was aimed at determining the factors influencing malaria parasite prevalence and density as well as anaemia in HIV-infected children in Mutengene, Cameroon from November, 2012 to April, 2013. METHODS A semi-structured questionnaire was used to record information on socio-demographic factors and use of preventive measures by caregivers of HIV-infected children aged 1-15 years and of both sexes. Venous blood was collected; blood films were prepared and Giemsa-stained for parasite detection and speciation. Haemoglobin concentration was measured and the anaemic status determined. Data was analysed using Epi Info 7 software. RESULTS A total of 234 children were studied. The overall malaria parasite prevalence was 24.8 % (58) and was significantly higher (31.9 %, P = 0 .004) in females, those who did not implement any preventive measure at all (66.7 %, P = 0.03) and children who used antiretroviral therapy (ART) (28.6 %, P = 0.02) when compared with their respective counterparts. Geometric mean parasite density (GMPD) was significantly higher (3098.4, P = 0.02) in children who presented with fever, had CD4 T cells ≥500 cells/μL (491.3, P = 0.003) and those with moderate anaemia (1658.8, P = 0.03) than their respective counterparts. Although there was no significant difference, GMPD was however higher in males (549.0); those not on ART (635.0) and highest in children <5 years old (633.0) than their respective counterparts. The overall prevalence of anaemia was 49.6 % (116). The value was significantly highest (58.3 %, P = 0.01) in the 11-15 years age group; those with CD4 T cell level 200-499 (72.7 %, P = 0.001) and children with fever (85.7 %, P = 0.01). CONCLUSION Implementation of proper and integrated malaria preventive measures as well as frequent monitoring of anaemia on prescription of ART could likely improve the health conditions of HIV-infected children thus avoiding malaria-related morbidity and mortality.
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Affiliation(s)
- Ayukenchengamba Bate
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon.
| | - Helen K Kimbi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon.,Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Bamenda, Bamenda, P.O. Box 39, Bambili, NWR, Cameroon
| | - Emmaculate Lum
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon.,Department of Biological Sciences, Higher Teachers' Training College, University of Yaounde I, P.O. Box 47, Yaounde, Centre Region, Cameroon
| | - Leopold G Lehman
- Department of Animal Biology, Faculty of Science, University of Douala, P.O. Box 2701, Douala, Littoral Region, Cameroon
| | - Elias F Onyoh
- AIDS Care and Prevention Program, Cameroon Baptist Convention Health Services, Bamenda, Cameroon.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Lucy M Ndip
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon
| | - Conica M Njabi
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon
| | - Calvin Tonga
- Department of Animal Biology, Faculty of Science, University of Douala, P.O. Box 2701, Douala, Littoral Region, Cameroon
| | - Godlove B Wempnje
- Department of Zoology and Animal Physiology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon
| | - Roland N Ndip
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, P.O. Box 63, Buea, SWR, Cameroon.,Department of Biochemistry and Microbiology, Faculty of Science and Agriculture, University of Fort Hare, PMB X1314, Alice, 5700, South Africa
| | - Pascal O Bessong
- HIV/AIDS and Global Health Research Programme, Department of Microbiology, University of Venda, Thohoyandou, 0950, South Africa
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Boettiger DC, Muktiarti D, Kurniati N, Truong KH, Saghayam S, Ly PS, Hansudewechakul R, Van Nguyen L, Do VC, Sudjaritruk T, Lumbiganon P, Chokephaibulkit K, Bunupuradah T, Nik Yusoff NK, Wati DK, Mohd Razali KA, Fong MS, Nallusamy RA, Sohn AH, Kariminia A. Early Height and Weight Changes in Children Using Cotrimoxazole Prophylaxis With Antiretroviral Therapy. Clin Infect Dis 2016; 63:1236-1244. [PMID: 27470239 DOI: 10.1093/cid/ciw514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/21/2016] [Indexed: 12/22/2022] Open
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.
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Affiliation(s)
- David C Boettiger
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Nia Kurniati
- Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | | | - Suneeta Saghayam
- Y.R. Gaitonde Center for AIDS Research and Education Medical Centre, Chennai, India
| | - Penh Sun Ly
- National Centre for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia
| | | | | | - Viet Chau Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Tavitiya Sudjaritruk
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai
| | | | | | - Torsak Bunupuradah
- HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | | | | | | | | | | | - Annette H Sohn
- TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand
| | - Azar Kariminia
- The Kirby Institute, University of New South Wales, Sydney, Australia
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Abstract
BACKGROUND Information on antiretroviral therapy (ART) use in HIV-infected children with severe malnutrition (SM) is lacking. We investigated long-term ART outcomes in this population. METHODS Children enrolled in the TREAT Asia Pediatric HIV Observational Database who had SM (weight-for-height or body mass index-for-age Z score less than -3) at ART initiation were analyzed. Generalized estimating equations were used to investigate poor weight recovery (weight-for-age Z score less than -3) and poor CD4% recovery (CD4% <25), and competing risk regression was used to analyze mortality and toxicity-associated treatment modification. RESULTS Three hundred fifty-five (11.9%) of 2993 children starting ART had SM. Their median weight-for-age Z score increased from -5.6 at ART initiation to -2.3 after 36 months. Not using trimethoprim-sulfamethoxazole prophylaxis at baseline was associated with poor weight recovery [odds ratio: 2.49 vs. using; 95% confidence interval (CI): 1.66-3.74; P < 0.001]. Median CD4% increased from 3.0 at ART initiation to 27.2 after 36 months, and 56 (15.3%) children died during follow-up. More profound SM was associated with poor CD4% recovery (odds ratio: 1.78 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.08-2.92; P = 0.023) and mortality (hazard ratio: 2.57 for Z score less than -4.5 vs. -3.5 to less than -3.0; 95% CI: 1.24-5.33; P = 0.011). Twenty-two toxicity-associated ART modifications occurred at a rate of 2.4 per 100 patient-years, and rates did not differ by malnutrition severity. CONCLUSION Trimethoprim-sulfamethoxazole prophylaxis is important for the recovery of weight-for-age in severely malnourished children starting ART. The extent of SM does not impede weight-for-age recovery or antiretroviral tolerability, but CD4% response is compromised in children with a very low weight-for-height/body mass index-for-age Z score, which may contribute to their high rate of mortality.
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Boettiger DC, Sudjaritruk T, Nallusamy R, Lumbiganon P, Rungmaitree S, Hansudewechakul R, Kumarasamy N, Bunupuradah T, Saphonn V, Truong HK, Yusoff NKN, Do CV, Nguyen LV, Razali KAM, Fong SM, Kurniati N, Kariminia A. Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy in Perinatally HIV-Infected, Treatment-Naïve Adolescents in Asia. J Adolesc Health 2016; 58:451-459. [PMID: 26803201 PMCID: PMC4808326 DOI: 10.1016/j.jadohealth.2015.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/22/2015] [Accepted: 11/25/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE About a third of untreated, perinatally HIV-infected children reach adolescence. We evaluated the durability and effectiveness of non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based antiretroviral therapy (ART) in this population. METHODS Data from perinatally HIV-infected, antiretroviral-naïve patients initiated on NNRTI-based ART aged 10-19 years who had ≥6 months of follow-up were analyzed. Competing risk regression was used to assess predictors of NNRTI substitution and clinical failure (World Health Organization Stage 3/4 event or death). Viral suppression was defined as a viral load <400 copies/mL. RESULTS Data from 534 adolescents met our inclusion criteria (56.2% female; median age at treatment initiation 11.8 years). After 5 years of treatment, median height-for-age z score increased from -2.3 to -1.6, and median CD4+ cell count increased from 131 to 580 cells/mm(3). The proportion of patients with viral suppression after 6 months was 87.6% and remained >80% up to 5 years of follow-up. NNRTI substitution and clinical failure occurred at rates of 4.9 and 1.4 events per 100 patient-years, respectively. Not using cotrimoxazole prophylaxis at ART initiation was associated with NNRTI substitution (hazard ratio [HR], 1.5 vs. using; 95% confidence interval [CI] = 1.0-2.2; p = .05). Baseline CD4+ count ≤200 cells/mm(3) (HR, 3.3 vs. >200; 95% CI = 1.2-8.9; p = .02) and not using cotrimoxazole prophylaxis at ART initiation (HR, 2.1 vs. using; 95% CI = 1.0-4.6; p = .05) were both associated with clinical failure. CONCLUSIONS Despite late ART initiation, adolescents achieved good rates of catch-up growth, CD4+ count recovery, and virological suppression. Earlier ART initiation and routine cotrimoxazole prophylaxis in this population may help to reduce current rates of NNRTI substitution and clinical failure.
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Affiliation(s)
- David C Boettiger
- Faculty of Medicine, The Kirby Institute, UNSW Australia, Sydney, New South Wales, Australia.
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Jesson J, Masson D, Adonon A, Tran C, Habarugira C, Zio R, Nicimpaye L, Desmonde S, Serurakuba G, Kwayep R, Sare E, Konate T, Nimaga A, Saina P, Kpade A, Bassuka A, Gougouyor G, Leroy V. Prevalence of malnutrition among HIV-infected children in Central and West-African HIV-care programmes supported by the Growing Up Programme in 2011: a cross-sectional study. BMC Infect Dis 2015; 15:216. [PMID: 26007232 PMCID: PMC4494161 DOI: 10.1186/s12879-015-0952-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of malnutrition among HIV-infected children is not well described in sub-Saharan Africa, even though it is an important problem to take into account to guarantee appropriate healthcare for these children. We assessed the prevalence of malnutrition and its associated factors among HIV-infected children in HIV care programmes in Central and West-Africa. METHODS A cross-sectional study was conducted from September to December 2011 among the active files of HIV-infected children aged 2-19 years old, enrolled in HIV-care programmes supported by the Sidaction Growing Up Programme in Benin, Burundi, Cameroon, Côte d'Ivoire, Mali, Chad and Togo. Socio-demographics characteristics, anthropometric, clinical data, and nutritional support were collected. Anthropometric indicators, expressed in Z-scores, were used to define malnutrition: Height-for-age (HAZ), Weight-for-Height (WHZ) for children < 5 years and BMI-for-age (BAZ) for children ≥5 years. Three types of malnutrition were defined: acute malnutrition (WHZ/BAZ < -2 SD and HAZ ≥ -2 SD), chronic malnutrition (HAZ < -2 SD and WHZ/BAZ ≥ -2 SD) and mixed malnutrition (WHZ/BAZ < -2 SD and HAZ < -2 SD). A multinomial logistic regression model explored associated factors with each type of malnutrition. RESULTS Overall, 1350 HIV-infected children were included; their median age was 10 years (interquartile range [IQR]: 7-13 years), 49 % were girls. 80 % were on antiretroviral treatment (ART), for a median time of 36 months. The prevalence of malnutrition was 42 % (95 % confidence interval [95% CI]: 40-44 %) with acute, chronic and mixed malnutrition at 9 % (95% CI: 6-12 %), 26 % (95% CI: 23-28 %), and 7 % (95% CI: 5-10 %), respectively. Among those malnourished, more than half of children didn't receive any nutritional support at the time of the survey. Acute malnutrition was associated with male gender, severe immunodeficiency, and the absence of ART; chronic malnutrition with male gender and age (<5 years); and mixed malnutrition with male gender, age (<5 years), severe immunodeficiency and recent ART initiation (<6 months). Orphanhood and Cotrimoxazole prophylaxis were not associated with any type of malnutrition. CONCLUSIONS The prevalence of malnutrition in HIV-infected children even on ART remains high in HIV care programmes. Anthropometric measurements and appropriate nutritional care of malnourished HIV-infected children remain insufficient and a priority to improve health care of HIV-infected children in Africa.
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Affiliation(s)
- Julie Jesson
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. .,Centre de Recherche Inserm U897, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen Case 11, 146 rue Léo Saignat, 33076, Bordeaux, Cedex, France.
| | - David Masson
- Growing Up Programme - Sidaction & Initiative Développement, Paris, France.
| | - Arsène Adonon
- RACINES (Recherches Actions Communautaires Initiatives pour un Nouvel Espoir), Cotonou, Bénin.
| | - Caroline Tran
- Growing Up Programme - Sidaction & Initiative Développement, Paris, France.
| | - Capitoline Habarugira
- ANSS (Association Nationale de Soutien aux Séropositifs et malades du Sida), Bujumbura, Burundi.
| | - Réjane Zio
- Growing Up Programme - Sidaction & Initiative Développement, Paris, France.
| | - Léoncie Nicimpaye
- APECOS (Association de Prise en Charge des Orphelins du Sida ), Bujumbura, Burundi.
| | - Sophie Desmonde
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. .,Centre de Recherche Inserm U897, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen Case 11, 146 rue Léo Saignat, 33076, Bordeaux, Cedex, France.
| | - Goreth Serurakuba
- SWAA (Society for Women against AIDS in Africa ) - Burundi, Bujumbura, Burundi.
| | - Rosine Kwayep
- SWAA Littoral (Society for Women against AIDS in Africa), Douala, Cameroon.
| | - Edith Sare
- CSAS (Centre Solidarité Action Sociale), Bouaké, Ivory Coast.
| | - Tiefing Konate
- ARCAD (Association de Recherche, de Communication et d'Accompagnement à Domicile des personnes vivant avec le VIH et le sida), Bamako, Mali.
| | | | | | | | | | - Gustave Gougouyor
- CRIPS (Centre de Recherche de d'Information Pour la Santé ) - Togo, Lomé, Togo.
| | - Valériane Leroy
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France. .,Centre de Recherche Inserm U897, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Université Bordeaux Segalen Case 11, 146 rue Léo Saignat, 33076, Bordeaux, Cedex, France.
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Brüssow H. Growth promotion and gut microbiota: insights from antibiotic use. Environ Microbiol 2015; 17:2216-27. [DOI: 10.1111/1462-2920.12786] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Harald Brüssow
- Nutrition and Health Department; Nestlé Research Center; Vers-chez-les-Blanc CH-1000 Lausanne 26 Lausanne Switzerland
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Church JA, Fitzgerald F, Walker AS, Gibb DM, Prendergast AJ. The expanding role of co-trimoxazole in developing countries. THE LANCET. INFECTIOUS DISEASES 2015; 15:327-39. [PMID: 25618179 DOI: 10.1016/s1473-3099(14)71011-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Co-trimoxazole is an inexpensive, broad-spectrum antimicrobial drug that is widely used in developing countries. Before antiretroviral therapy (ART) scale-up, co-trimoxazole prophylaxis reduced morbidity and mortality in adults and children with HIV by preventing bacterial infections, diarrhoea, malaria, and Pneumocystis jirovecii pneumonia, despite high levels of microbial resistance. Co-trimoxazole prophylaxis reduces early mortality by 58% (95% CI 39-71) in adults starting ART. Co-trimoxazole provides ongoing protection against malaria and non-malaria infections after immune reconstitution in ART-treated individuals in sub-Saharan Africa, leading to a change in WHO guidelines, which now recommend long-term co-trimoxazole prophylaxis for adults and children in settings with a high prevalence of malaria or severe bacterial infections. Co-trimoxazole prophylaxis is recommended for HIV-exposed infants from age 4-6 weeks; however, the risks and benefits of co-trimoxazole during infancy are unclear. Co-trimoxazole prophylaxis reduces anaemia and improves growth in children with HIV, possibly by reducing inflammation, either through direct immunomodulatory activity or through effects on the intestinal microbiota leading to reduced microbial translocation. Ongoing trials are now assessing the ability of adjunctive co-trimoxazole to reduce mortality in children after severe anaemia or severe acute malnutrition. In this Review, we discuss the mechanisms of action, benefits and risks, and clinical trials of co-trimoxazole in developing countries.
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Affiliation(s)
- James A Church
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, UK
| | | | - A Sarah Walker
- MRC Clinical Trials Unit at University College London, London, UK
| | - Diana M Gibb
- MRC Clinical Trials Unit at University College London, London, UK
| | - Andrew J Prendergast
- Centre for Paediatrics, Blizard Institute, Queen Mary University of London, London, UK; MRC Clinical Trials Unit at University College London, London, UK; Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe.
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Ebissa G, Deyessa N, Biadgilign S. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia. AIDS Care 2015; 27:723-30. [PMID: 25599414 DOI: 10.1080/09540121.2014.997180] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Highly active antiretroviral therapy (HAART) is the breakthrough in care and treatment of people living with HIV, leading to a reduction in mortality and an improvement in the quality of life. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday. So the objective of this study is to determine the mortality and associated factors in a cohort of HIV-infected children receiving ART in Ethiopia. A multicentre facility-based retrospective cohort study was done in selected pediatric ART units in hospitals found in Addis Ababa, Ethiopia. The probability of survival was estimated using the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards regression models was conducted to determine the independent predictor of survival. A total of 556 children were included in this study. Of the total children, 10.4% were died in the overall cohort. More deaths (70%) occurred in the first 6 months of ART initiation, and the remaining others were still on follow-up at different hospitals. Underweight (moderate and severe; HR: 10.10; 95% CI: 2.08, 28.00; P = 0.004; and HR: 46.69; 95% CI: 9.26, 200.45; P < 0.01, respectively), advanced disease stage (WHO clinical stages III and IV; HR: 10.13: 95% CI: 2.25, 45.58; P = 0.003), poor ART adherence (HR: 11.72; 95% CI: 1.60, 48.44; P = 0.015), and hemoglobin level less than 7 g/dl (HR: 4.08: 95% CI: 1.33, 12.56; P = 0.014) were confirmed as significant independent predictors of death after controlling for other factors. Underweight, advanced disease stage, poor adherence to ART, and anemia appear to be independent predictor of survival in HIV-infected children receiving HAART at the pediatric units of public hospitals in Ethiopia. Nutritional supplementations, early initiation of HAART, close supervision, and monitoring of patients during the first 6 months, the follow up period is recommended.
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Affiliation(s)
- Getachew Ebissa
- a Department of General Public Health, College of Health Sciences , Haramaya University , Harar , Ethiopia
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Carrascosa MF, Mones JC, Salcines-Caviedes JR, Román JG. A man with unsuspected marine eosinophilic gastritis. THE LANCET. INFECTIOUS DISEASES 2014; 15:248. [PMID: 25467651 DOI: 10.1016/s1473-3099(14)70892-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Miguel F Carrascosa
- Department of Internal Medicine, Hospital of Laredo, Laredo, Cantabria, Spain.
| | | | | | - Javier Gómez Román
- Molecular Biology Laboratory, Pathology Department, University Hospital Marqués de Valdecilla, Faculty of Medicine, Santander, Cantabria, Spain
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Mwiru RS, Spiegelman D, Duggan C, Seage GR, Semu H, Chalamilla G, Kisenge R, Fawzi WW. Growth among HIV-infected children receiving antiretroviral therapy in Dar es Salaam, Tanzania. J Trop Pediatr 2014; 60:179-88. [PMID: 24393831 PMCID: PMC4040821 DOI: 10.1093/tropej/fmt104] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We assembled a prospective cohort of 3144 human immunodeficiency virus (HIV) infected children aged <15 years initiating antiretroviral therapy (ART) in Dar es Salaam, Tanzania. The prospective relationships of baseline covariates with growth were examined using linear regression models. ART led to improvement in mean weight-for-age (WAZ), height/length-for-age (HAZ) and weight-for-length or body mass index (WLZ/BMIZ) scores. However, normal HAZ values were not attained over an average follow-up of 17.2 months. After 6 months of ART, underweight (P < 0.001), low CD4 count or percent (P < 0.001), stavudine containing regimens (P = 0.05) and advanced WHO disease stage (P < 0.001) at ART initiation were associated with better WAZ scores. Age >5 years on the other hand was associated with less increase in WAZ score after 6 months of ART (P < 0.001). These findings suggest that although ART improved the growth of the HIV-infected children in Tanzania, adjunct nutritional interventions may be needed to ensure that the growth of these children is optimized to the greatest extent possible.
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Affiliation(s)
| | - Donna Spiegelman
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Christopher Duggan
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Center for Nutrition, Division of GI/Nutrition, Boston Children’s Hospital, Boston, Massachusetts 02115, USA
| | - George R. Seage
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Helen Semu
- Ministry of Health and Social Welfare, Dar es Salaam, Tanzania
| | - Guerino Chalamilla
- Management and Development for Health (MDH), Dar es Salaam, Tanzania,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA
| | - Rodrick Kisenge
- Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Wafaie W. Fawzi
- Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts 02115, USA,Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts 02115, USA
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Jones KD, Thitiri J, Ngari M, Berkley JA. Childhood malnutrition: toward an understanding of infections, inflammation, and antimicrobials. Food Nutr Bull 2014; 35:S64-70. [PMID: 25069296 PMCID: PMC4257992 DOI: 10.1177/15648265140352s110] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Undernutrition in childhood is estimated to cause 3.1 million child deaths annually through a potentiating effect on common infectious diseases, such as pneumonia and diarrhea. In turn, overt and subclinical infections, and inflammation, especially in the gut, alter nutrient intake, absorption, secretion, diversion, catabolism, and expenditure. OBJECTIVE A narrative overview of the current understanding of infections, inflammation, and antimicrobials in relation to childhood malnutrition. METHODS Searches for pivotal papers were conducted using PUBMED 1966-January 2013; hand searches of the references of retrieved literature; discussions with experts; and personal experience from the field. RESULTS Although the epidemiological evidence for increased susceptibility to life-threatening infections associated with malnutrition is strong, we are only just beginning to understand some of the mechanisms involved. Nutritional status and growth are strongly influenced by environmental enteric dysfunction (EED), which is common among children in developing countries, and by alterations in the gut microbiome. As yet, there are no proven interventions against EED. Antibiotics have long been used as growth promoters in animals. Trials of antibiotics have shown striking efficacy on mortality and on growth in children with uncomplicated severe acute malnutrition (SAM) or HIV infection. Antibiotics act directly by preventing infections and may act indirectly by reducing subclinical infections and inflammation. We describe an ongoing multicenter, randomized, placebo-controlled trial of daily cotrimoxazole prophylaxis to prevent death in children recovering from complicated SAM. Secondary outcomes include growth, frequency and etiology of infections, immune activation and function, the gut microbiome, and antimicrobial resistance. The trial is expected to be reported in mid-2014. CONCLUSIONS As well as improving nutritional intake, new case management strategies need to address infection, inflammation, and microbiota and assess health outcomes rather than only anthropometry.
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Dicko F, Desmonde S, Koumakpai S, Dior-Mbodj H, Kouéta F, Baeta N, Koné N, Akakpo J, Signate Sy H, Ye D, Renner L, Lewden C, Leroy V. Reasons for hospitalization in HIV-infected children in West Africa. J Int AIDS Soc 2014; 17:18818. [PMID: 24763078 PMCID: PMC3999943 DOI: 10.7448/ias.17.1.18818] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 02/17/2014] [Accepted: 03/12/2014] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Current knowledge on morbidity and mortality in HIV-infected children comes from data collected in specific research programmes, which may offer a different standard of care compared to routine care. We described hospitalization data within a large observational cohort of HIV-infected children in West Africa (IeDEA West Africa collaboration). METHODS We performed a six-month prospective multicentre survey from April to October 2010 in five HIV-specialized paediatric hospital wards in Ouagadougou, Accra, Cotonou, Dakar and Bamako. Baseline and follow-up data during hospitalization were recorded using a standardized clinical form, and extracted from hospitalization files and local databases. Event validation committees reviewed diagnoses within each centre. HIV-related events were defined according to the WHO definitions. RESULTS From April to October 2010, 155 HIV-infected children were hospitalized; median age was 3 years [1-8]. Among them, 90 (58%) were confirmed for HIV infection during their stay; 138 (89%) were already receiving cotrimoxazole prophylaxis and 64 children (40%) had initiated antiretroviral therapy (ART). The median length of stay was 13 days (IQR: 7-23); 25 children (16%) died during hospitalization and four (3%) were transferred out. The leading causes of hospitalization were WHO stage 3 opportunistic infections (37%), non-AIDS-defining events (28%), cachexia and other WHO stage 4 events (25%). CONCLUSIONS Overall, most causes of hospitalizations were HIV related but one hospitalization in three was caused by a non-AIDS-defining event, mostly in children on ART. HIV-related fatality is also high despite the scaling-up of access to ART in resource-limited settings.
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Affiliation(s)
- Fatoumata Dicko
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Sophie Desmonde
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France;
| | - Sikiratou Koumakpai
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Fla Kouéta
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Niaboula Koné
- Service Pédiatrie Centre Hospitalier, Universitaire Gabriel Toure, Bamako, Mali
| | - Jocelyn Akakpo
- Service Pédiatrie, Centre National Hospitalier Universitaire, Cotonou, Bénin
| | | | - Diarra Ye
- Service Pédiatrie, Hopital Général de Gaulle, Ouagadougou, Burkina Faso
| | | | - Charlotte Lewden
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
| | - Valériane Leroy
- Inserm, Centre Inserm U897 - Epidémiologie - Biostatistiques, University of Bordeaux, Bordeaux, France; University of Bordeaux, ISPED, Centre Inserm U897 - Epidémiologie - Biostatistiques, Bordeaux, France
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Gough EK, Moodie EEM, Prendergast AJ, Johnson SMA, Humphrey JH, Stoltzfus RJ, Walker AS, Trehan I, Gibb DM, Goto R, Tahan S, de Morais MB, Manges AR. The impact of antibiotics on growth in children in low and middle income countries: systematic review and meta-analysis of randomised controlled trials. BMJ 2014; 348:g2267. [PMID: 24735883 PMCID: PMC3988318 DOI: 10.1136/bmj.g2267] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine whether antibiotic treatment leads to improvements in growth in prepubertal children in low and middle income countries, to determine the magnitude of improvements in growth, and to identify moderators of this treatment effect. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline, Embase, Scopus, the Cochrane central register of controlled trials, and Web of Science. STUDY SELECTION Randomised controlled trials conducted in low or middle income countries in which an orally administered antibacterial agent was allocated by randomisation or minimisation and growth was measured as an outcome. Participants aged 1 month to 12 years were included. Control was placebo or non-antimicrobial intervention. RESULTS Data were pooled from 10 randomised controlled trials representing 4316 children, across a variety of antibiotics, indications for treatment, treatment regimens, and countries. In random effects models, antibiotic use increased height by 0.04 cm/month (95% confidence interval 0.00 to 0.07) and weight by 23.8 g/month (95% confidence interval 4.3 to 43.3). After adjusting for age, effects on height were larger in younger populations and effects on weight were larger in African studies compared with other regions. CONCLUSION Antibiotics have a growth promoting effect in prepubertal children in low and middle income countries. This effect was more pronounced for ponderal than for linear growth. The antibiotic growth promoting effect may be mediated by treatment of clinical or subclinical infections or possibly by modulation of the intestinal microbiota. Better definition of the mechanisms underlying this effect will be important to inform optimal and safe approaches to achieving healthy growth in vulnerable populations.
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Affiliation(s)
- Ethan K Gough
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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Morbidity and health care resource utilization in HIV-infected children after antiretroviral therapy initiation in Côte d'Ivoire, 2004-2009. J Acquir Immune Defic Syndr 2014; 65:e95-103. [PMID: 24525473 DOI: 10.1097/qai.0b013e3182a4ea6f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We describe severe morbidity and health care resource utilization (HCRU) among HIV-infected children on antiretroviral therapy (ART) in Abidjan, Côte d'Ivoire. METHODS All HIV-infected children enrolled in an HIV-care program (2004-2009) were eligible for ART initiation until database closeout, death, ART interruption, or loss to follow-up. We calculated incidence rates (IRs) of density per 100 child-years (CYs) for severe morbidity, HCRU (outpatient care and inpatient care), and associated factors using frailty models with a Weibull distribution. RESULTS Of 332 children with a median age of 5.7 years and median follow-up of 2.5 years, 65.4% were severely immunodeficient by World Health Organization (WHO) criteria, and all received cotrimoxazole prophylaxis. We recorded 464 clinical events in 228 children; the overall IR was 57.6/100 CYs [95% confidence interval (CI): 52.1 to 62.5]. Severe morbidity was more frequent in children on protease inhibitor (PI)-based ART compared to those on other regimens [adjusted hazards ratio (aHR): 1.83; 95% CI: 1.35 to 2.47] and to those moderately/severely immunodeficient compared to those not (aHR: 1.57; 95% CI: 1.13 to 2.18 and aHR: 2.53; 95% CI: 1.81 to 3.55, respectively). Of the 464 events, 371 (80%) led to outpatient care (IR: 45.6/100 CYs) and 164 (35%) to inpatient care (IR: 20.2/100 CYs). In adjusted analyses, outpatient care was significantly less frequent in children older than 10 years compared with children younger than 2 years (aHR: 0.49; 95% CI: 0.31 to 0.78) and in those living furthest from clinics compared with those living closest (aHR: 0.65; 95% CI: 0.47 to 0.90). Both inpatient and outpatient HCRU were negatively associated with cotrimoxazole prophylaxis. CONCLUSIONS Despite ART, HIV-infected children still require substantial utilization of health care services.
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Bwakura-Dangarembizi M, Kendall L, Bakeera-Kitaka S, Nahirya-Ntege P, Keishanyu R, Nathoo K, Spyer MJ, Kekitiinwa A, Lutaakome J, Mhute T, Kasirye P, Munderi P, Musiime V, Gibb DM, Walker AS, Prendergast AJ. A randomized trial of prolonged co-trimoxazole in HIV-infected children in Africa. N Engl J Med 2014; 370:41-53. [PMID: 24382064 PMCID: PMC4264559 DOI: 10.1056/nejmoa1214901] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Co-trimoxazole (fixed-dose trimethoprim-sulfamethoxazole) prophylaxis administered before antiretroviral therapy (ART) reduces morbidity in children infected with the human immunodeficiency virus (HIV). We investigated whether children and adolescents receiving long-term ART in sub-Saharan Africa could discontinue co-trimoxazole. METHODS We conducted a randomized, noninferiority trial of stopping versus continuing daily open-label co-trimoxazole in children and adolescents in Uganda and Zimbabwe. Eligible participants were older than 3 years of age, had been receiving ART for more than 96 weeks, were using insecticide-treated bed nets (in malaria-endemic areas), and had not had Pneumocystis jirovecii pneumonia. Coprimary end points were hospitalization or death and adverse events of grade 3 or 4. RESULTS A total of 758 participants were randomly assigned to stop or continue co-trimoxazole (382 and 376 participants, respectively), after receiving ART for a median of 2.1 years (interquartile range, 1.8 to 2.3). The median age was 7.9 years (interquartile range, 4.6 to 11.1), and the median CD4 T-cell percentage was 33% (interquartile range, 26 to 39). Participants who stopped co-trimoxazole had higher rates of hospitalization or death than those who continued (72 participants [19%] vs. 48 [13%]; hazard ratio, 1.64; 95% confidence interval [CI], 1.14 to 2.37; P = 0.007; noninferiority not shown). There was no evidence of variation across ages (P=0.93 for interaction). A total of 2 participants in the prophylaxis-stopped group (1%) died, as did 3 in the prophylaxis-continued group (1%). Most hospitalizations in the prophylaxis-stopped group were for malaria (49 events, vs. 21 in the prophylaxis-continued group) or infections other than malaria (53 vs. 25), particularly pneumonia, sepsis, and meningitis. Rates of adverse events of grade 3 or 4 were similar in the two groups (hazard ratio, 1.20; 95% CI, 0.83 to 1.72; P=0.33), but more grade 4 adverse events occurred in the prophylaxis-stopped group (hazard ratio, 2.04; 95% CI, 0.99 to 4.22; P=0.05), with anemia accounting for the largest number of events (12, vs. 2 with continued prophylaxis). CONCLUSIONS Continuing co-trimoxazole prophylaxis after 96 weeks of ART was beneficial, as compared with stopping prophylaxis, with fewer hospitalizations for both malaria and infection not related to malaria. (Funded by the United Kingdom Medical Research Council and others; ARROW Current Controlled Trials number, ISRCTN24791884.).
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Affiliation(s)
- Mutsawashe Bwakura-Dangarembizi
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Lindsay Kendall
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Sabrina Bakeera-Kitaka
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Patricia Nahirya-Ntege
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Rosette Keishanyu
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Kusum Nathoo
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Moira J Spyer
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Adeodata Kekitiinwa
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Joseph Lutaakome
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Tawanda Mhute
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Philip Kasirye
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Paula Munderi
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Victor Musiime
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Diana M Gibb
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - A Sarah Walker
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
| | - Andrew J Prendergast
- University of Zimbabwe, College of Health Sciences, Harare (M.B.-D., K.N., T.M.); the Medical Research Council Clinical Trials Unit at University College London (L.K., M.J.S., D.M.G., A.S.W., A.J.P.) and Centre for Paediatrics, Blizard Institute, Queen Mary, University of London (A.J.P.), London; and the Paediatric Infectious Diseases Clinic of Baylor Uganda, Mulago Hospital (S.B.-K., A.K., P.K.), and Joint Clinical Research Center (R.K., V.M.), Kampala, and the Medical Research Council and Uganda Virus Research Institute, Uganda Research Unit on AIDS, Entebbe (P.N.-N., J.L., P.M.) - all in Uganda
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Kamya MR, Byakika-Kibwika P, Gasasira AF, Havlir D, Rosenthal PJ, Dorsey G, Achan J. The effect of HIV on malaria in the context of the current standard of care for HIV-infected populations in Africa. Future Virol 2012; 7:699-708. [PMID: 23293660 DOI: 10.2217/fvl.12.59] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HIV infection affects the clinical pattern of malaria. There is emerging evidence to suggest that previously documented interactions may be modified by recently scaled-up HIV and malaria interventions. Prophylaxis with trimethoprim-sulfamethoxazole (TS) in combination with use of insecticide-treated nets can markedly decrease the incidence of malaria in HIV-infected pregnant and nonpregnant adults and children even in the setting of antifolate resistance-conferring mutations that are currently common in Africa. Nonetheless, additional interventions are needed to protect HIV-infected people that reside in high-malaria-transmission areas. Artemether-lumefantrine and dihydroartemisinin-piperaquine are highly efficacious and safe for the treatment of uncomplicated malaria in HIV-infected persons. Coadministration of antiretroviral and antimalarial drugs creates the potential for pharmacokinetic drug interactions that may increase (causing enhancement of malaria treatment efficacy and post-treatment prophylaxis and/or unanticipated toxicity) or reduce (creating risk for treatment failure) antimalarial drug exposure. Further studies are needed to elucidate potentially important pharmacokinetic interactions between commonly used antimalarials, antiretrovirals and TS and their clinical implications. Data on the benefits of long-term TS prophylaxis among HIV patients on antiretroviral therapy who have achieved immune-reconstitution are limited. Studies to address these questions are ongoing or planned, and the results should provide the evidence base required to guide the prevention and treatment of malaria in HIV-infected patients.
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Affiliation(s)
- Moses R Kamya
- Makerere University College of Health Sciences, PO Box 7072, Kampala, Uganda
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