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. 2016 Nov 1;63(9):1236-1244.
doi: 10.1093/cid/ciw514. Epub 2016 Jul 28.

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

David C Boettiger  1 , Dina Muktiarti  2 , Nia Kurniati  2 , Khanh H Truong  3 , Suneeta Saghayam  4 , Penh Sun Ly  5 , Rawiwan Hansudewechakul  6 , Lam Van Nguyen  7 , Viet Chau Do  8 , Tavitiya Sudjaritruk  9 , Pagakrong Lumbiganon  10 , Kulkanya Chokephaibulkit  11 , Torsak Bunupuradah  12 , Nik Khairulddin Nik Yusoff  13 , Dewi Kumara Wati  14 , Kamarul Azahar Mohd Razali  15 , Moy Siew Fong  16 , Revathy A Nallusamy  17 , Annette H Sohn  18 , Azar Kariminia  1 ; Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) Pediatric HIV Observational Database
Collaborators, Affiliations

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

David C Boettiger et al. Clin Infect Dis. .

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.

Keywords: antiretroviral therapy; children; cotrimoxazole; height; weight.

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Figures

Figure 1.
Figure 1.
Adjusted mean change in height-for-age z-score by cotrimoxazole use with baseline CD4 percentage ≥25% (A), 10%–24% (B), and <10% (C). Means and overall P values were estimated using generalized estimating equations. Models were adjusted for baseline age, baseline height-for-age z-score, anemia status, country income status, and period of antiretroviral therapy initiation. Error bars represent 95% confidence interval around the mean.
Figure 2.
Figure 2.
Adjusted mean change in weight-for-age z-score by cotrimoxazole use with baseline CD4 percentage ≥25% (A), 10%–24% (B), and <10% (C). Means and overall P values were estimated using generalized estimating equations. Models were adjusted for baseline age, baseline weight-for-age z-score, anemia status, country income status, and period of antiretroviral therapy initiation. Error bars represent 95% confidence interval around the mean.
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References

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