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

David C. Boettiger, Matthew G. Law, Annette H. Sohn, Mary Ann Davies, Kara Wools-Kaloustian, Valeriane Leroy, Marcel Yotebieng, Michael Vinikoor, Rachel Vreeman, Madeleine Amorissani-Folquet, Andrew Edmonds, Geoffrey Fatti, James Batte, Lorna Renner, Adebola Adedimeji, Azar Kariminia

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)450-460
Number of pages11
JournalJournal of the Pediatric Infectious Diseases Society
Volume8
Issue number5
DOIs
StatePublished - Mar 20 2019

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Sulfamethoxazole Drug Combination Trimethoprim
Mortality
Confidence Intervals
Odds Ratio
Therapeutics
Southern Africa
Eastern Africa
Secondary Prevention
Anemia
Acquired Immunodeficiency Syndrome
Epidemiology
Logistic Models
HIV
Databases
Pediatrics

Keywords

  • antiretroviral therapy
  • children
  • co-trimoxazole
  • HIV

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases

Cite this

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. / Boettiger, David C.; Law, Matthew G.; Sohn, Annette H.; Davies, Mary Ann; Wools-Kaloustian, Kara; Leroy, Valeriane; Yotebieng, Marcel; Vinikoor, Michael; Vreeman, Rachel; Amorissani-Folquet, Madeleine; Edmonds, Andrew; Fatti, Geoffrey; Batte, James; Renner, Lorna; Adedimeji, Adebola; Kariminia, Azar.

In: Journal of the Pediatric Infectious Diseases Society, Vol. 8, No. 5, 20.03.2019, p. 450-460.

Research output: Contribution to journalArticle

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 2019, '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', Journal of the Pediatric Infectious Diseases Society, vol. 8, no. 5, pp. 450-460. https://doi.org/10.1093/jpids/piy087
Boettiger, David C. ; Law, Matthew G. ; Sohn, Annette H. ; Davies, Mary Ann ; Wools-Kaloustian, Kara ; Leroy, Valeriane ; Yotebieng, Marcel ; Vinikoor, Michael ; Vreeman, Rachel ; Amorissani-Folquet, Madeleine ; Edmonds, Andrew ; Fatti, Geoffrey ; Batte, James ; Renner, Lorna ; Adedimeji, Adebola ; Kariminia, Azar. / 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. In: Journal of the Pediatric Infectious Diseases Society. 2019 ; Vol. 8, No. 5. pp. 450-460.
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title = "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",
abstract = "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.",
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T1 - 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

AU - Boettiger, David C.

AU - Law, Matthew G.

AU - Sohn, Annette H.

AU - Davies, Mary Ann

AU - Wools-Kaloustian, Kara

AU - Leroy, Valeriane

AU - Yotebieng, Marcel

AU - Vinikoor, Michael

AU - Vreeman, Rachel

AU - Amorissani-Folquet, Madeleine

AU - Edmonds, Andrew

AU - Fatti, Geoffrey

AU - Batte, James

AU - Renner, Lorna

AU - Adedimeji, Adebola

AU - Kariminia, Azar

PY - 2019/3/20

Y1 - 2019/3/20

N2 - 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.

AB - 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.

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