title: The effect of cotrimoxazole prophylactic treatment on malaria, birth outcomes, and postpartum CD4 count in HIV-infected women.
abstract: BACKGROUND
  Limited data exist on cotrimoxazole prophylactic treatment (CPT) in pregnant women, including protection against malaria versus standard intermittent preventive therapy with sulfadoxine-pyrimethamine (IPTp).
  
  
  METHODS
  Using observational data we examined the effect of CPT in HIV-infected pregnant women on malaria during pregnancy, low birth weight and preterm birth using proportional hazards, logistic, and log binomial regression, respectively. We used linear regression to assess effect of CPT on CD4 count.
  
  
  RESULTS
  Data from 468 CPT-exposed and 768 CPT-unexposed women were analyzed. CPT was associated with protection against malaria versus IPTp (hazard ratio: 0.35, 95% Confidence Interval (CI): 0.20, 0.60). After adjustment for time period this effect was not statistically significant (adjusted hazard ratio: 0.66, 95% CI: 0.28, 1.52). Among women receiving and not receiving CPT, rates of low birth weight (7.1% versus 7.6%) and preterm birth (23.5% versus 23.6%) were similar. CPT was associated with lower CD4 counts 24 weeks postpartum in women receiving (-77.6 cells/ μ L, 95% CI: -125.2, -30.1) and not receiving antiretrovirals (-33.7 cells/ μ L, 95% CI: -58.6, -8.8).
  
  
  CONCLUSIONS
  Compared to IPTp, CPT provided comparable protection against malaria in HIV-infected pregnant women and against preterm birth or low birth weight. Possible implications of CPT-associated lower CD4 postpartum warrant further examination.
authors.affiliation: University of North Carolina Gillings School of Global Public Health, 2104 McGavran-Greenberg Hall, 135 Dauer Drive, CB 7435, Chapel Hill, NC 27599-7435, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Dow
authors.affiliation: UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi.
authors.forename: Dumbani
authors.initials: D
authors.lastname: Kayira
authors.affiliation: University of North Carolina Gillings School of Global Public Health, 3107-E McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.affiliation: University of North Carolina Gillings School of Global Public Health, 2104 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435, USA.
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
authors.affiliation: US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors.forename: Caroline C
authors.initials: CC
authors.lastname: King
authors.affiliation: US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors.forename: Sascha
authors.initials: S
authors.lastname: Ellington
authors.affiliation: UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi.
authors.forename: Nelecy
authors.initials: N
authors.lastname: Chome
authors.affiliation: US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors.forename: Athena
authors.initials: A
authors.lastname: Kourtis
authors.affiliation: The Ohio State University, N1145 Doan Hall, 410 W. 10th Avenue Columbus, OH 43210, USA.
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
authors.affiliation: UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi.
authors.forename: Zebrone
authors.initials: Z
authors.lastname: Kacheche
authors.affiliation: US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.affiliation: UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi ; Epidemiology and Biostatistics Division, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Charles
authors.initials: C
authors.lastname: Chasela
authors.affiliation: Division of Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599-7030, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: van der Horst
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control*; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood; D006801:Humans; D007230:Infant, Low Birth Weight; D008288:Malaria / Q000517:prevention & control*; D008295:Malawi; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011256:Pregnancy Outcome; D047928:Premature Birth; D012044:Regression Analysis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination