Malaria rebound in HIV exposed children after stopping cotrimoxazole prophylaxis

Introduction

All HIV-exposed infants born to mothers living with HIV must receive cotrimoxazole prophylaxis until HIV infection can be excluded and the infant or child is no longer exposed through breastfeeding. Because cotrimoxazole prophylaxis provides effective protection against malaria, it may modulate the development of malaria-specific immunity and potentially increase the risk of malaria after it is stopped (rebound effect). We are investigating the adherence to cotrimoxazole prophylaxis in HIV exposed children, and the risk of malaria and other morbidities during and after cotrimoxazole prophylaxis in the first two years of life.

Methodology

Two observational birth cohorts of 500 HIV exposed group on cotrimoxazole prophylaxis for 12 months and 500 non-HIV exposed group not on prophylaxis are followed until their 2nd birthday. HIV exposed children were recruited at the PMTCT clinic, while location and age-matched non-HIV exposed children were recruited simultaneously from the same source population. The incidence of malaria and all-cause morbidity and mortality will be compared during the first and second year of life using passive case detection.

Preliminary Results

Recruitment was completed by August 2012. Follow-up will be completed in August 2014. Retention rate to date is high (98%).

Conclusion

A better understanding of the risk and benefits of cotrimoxazole prophylaxis among HIV exposed children will help formulate effective, targeted interventions especially if a rebound phenomenon is observed.

Supervisors:

Kamija Phiri (CoM) & Feiko ter Kuile (LSTM)

Advisor:

Luis Cuevas (LSTM)