Browsing by Author "Law MG"

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    Temporal Trends in Co-trimoxazole Use Among Children on Antiretroviral Therapy and the Impact of Co-trimoxazole on Mortality Rates in Children Without Severe Immunodeficiency.
    (2019-Nov-06) Boettiger DC; Law MG; Sohn AH; Davies MA; Wools-Kaloustian K; Leroy V; Yotebieng M; Vinikoor M; Vreeman R; Amorissani-Folquet M; Edmonds A; Fatti G; Batte J; Renner L; Adedimeji A; Kariminia A; INSERM, Laboratoire d'Epidémiologie et Analyses en Santé Publique (LEASP)-UMR 1027, Toulouse, France.; Department of Paediatrics, University Hospital of Cocody, Abidjan, Côte d'Ivoire.; Rakai Health Science Program, Uganda.; Department of Paediatrics, Korlebu Hospital, Accra, Ghana.; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.; Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa.; College of Public Health, The Ohio State University, Columbus.; TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand.; Centre for Infectious Disease Research in Zambia, Lusaka.; Kheth'Impilo AIDS Free Living, Cape Town, South Africa.; Department of Medicine, University of North Carolina at Chapel Hill.; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.; Indiana University School of Medicine, Indianapolis.; The Kirby Institute, University of New South Wales, Sydney, Australia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
    BACKGROUND: Co-trimoxazole is recommended for all children with human immunodeficiency virus. In this analysis, we evaluate trends in pediatric co-trimoxazole use and survival on co-trimoxazole in children using antiretroviral therapy (ART). METHODS: We used data collected between January 1, 2006, and March 31, 2016, from the International Epidemiology Databases to Evaluate AIDS. Logistic regression was used to evaluate factors associated with using co-trimoxazole at ART initiation. Competing risk regression was used to assess factors associated with death. RESULTS: A total of 54113 children were included in this study. The prevalence of co-trimoxazole use at ART initiation increased from 66.5% in 2006 to a peak of 85.6% in 2010 and then declined to 48.5% in 2015-2016. A similar trend was observed among children who started ART with severe immunodeficiency. After adjusting for year of ART initiation, younger age (odds ratio [OR], 1.18 for <1 vs 1 to <5 years of age [95% confidence interval (CI), 1.09-1.28]), lower height-for-age z score (OR, 1.15 for less than -3 vs greater than -2 [95% CI, 1.08-1.22]), anemia (OR, 1.08 [95% CI, 1.02-1.15]), severe immunodeficiency (OR, 1.25 [95% CI, 1.18-1.32]), and receiving care in East Africa (OR, 8.97 vs Southern Africa [95% CI, 8.17-9.85]) were associated with a high prevalence of co-trimoxazole use. Survival did not differ according to co-trimoxazole use in children without severe immunodeficiency (hazard ratio, 1.01 for nonusers versus users [95% CI, 0.77-1.34]). CONCLUSIONS: Recent declines in co-trimoxazole use may not be linked to the current shift toward early ART initiation. Randomized trial data might be needed to establish the survival benefit of co-trimoxazole in children without severe immunodeficiency.