title: Effect of cotrimoxazole prophylaxis on the incidence of malaria in HIV-infected children in 2012, in Abidjan, Côte d'Ivoire: a prospective cohort study.
abstract: BACKGROUND
  Cotrimoxazole prophylaxis has an antimalarial effect which could have an additional protective effect against malaria in HIV-infected children on antiretroviral therapy (ART). We measured the incidence and associated factors of malaria in HIV-infected children on ART and/or cotrimoxazole in Abidjan, Côte d'Ivoire.
  
  
  METHODS
  All HIV-infected children <16 years, followed-up in the IeDEA West-African paediatric cohort (pWADA) in Abidjan, were prospectively included from May to August 2012, the rainy season. Children presenting signs suggesting malaria had a thick blood smear and were classified as confirmed or probable malaria. We calculated incidence density rates (IR) per 100 child-years (CY). Risk factors were assessed using a Poisson regression model.
  
  
  RESULTS
  Overall, 1117 children were included, of whom 89 % were ART-treated and 67 % received cotrimoxazole. Overall, there were 51 malaria events occurring in 48 children: 28 confirmed and 23 probable; 94 % were uncomplicated malaria. The overall IR of malaria (confirmed and probable) was 18.3/100 CY (95 % CI: 13.3-23.4), varying from 4.2/100 CY (95 % CI: 1.1-7.3) in children on ART and cotrimoxazole to 57.3/100 CY (95 % CI: 7.1-107.6) for those receiving no treatment at all. In univariate analysis, age < 5 years was significantly associated with a 2-fold IR of malaria compared to age >10 years (incidence rate ratio [IRR] = 2.18, 95 % CI: 1.04-4.58). Adjusted for severe immunodeficiency, cotrimoxazole reduced significantly the IR of first malarial episode (adjusted IRR [aIRR] = 0.13, 95 % CI: 0.02-0.69 and aIRR = 0.05, 95 % CI:0.02-0.18 in those off and on ART respectively). Severe immunodeficiency increased significantly the malaria IR (aIRR = 4.03, 95 % CI: 1.55-10.47). When considering the IR of confirmed malaria only, this varied from 2.4/100 CY (95 % CI: 0.0-4.8) in children on ART and cotrimoxazole to 34.4/100 CY (95 % CI: 0.0-73.3) for those receiving no treatment at all. In adjusted analyses, the IR of malaria in children on both cotrimoxazole and ART was significantly reduced (aIRR = 0.05, 95 % CI: 0.01-0.24) compared to those receiving no treatment at all.
  
  
  CONCLUSIONS
  Cotrimoxazole prophylaxis was strongly protective against the incidence of malaria when associated with ART in HIV-infected children. Thus, these drugs should be provided as widely and durably as possible in all HIV-infected children <5 years of age.
authors.affiliation: Inserm U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. mounkailaida81@yahoo.fr.|University Bordeaux, ISPED, Centre Inserm, U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. mounkailaida81@yahoo.fr.
authors.forename: Aïda Mounkaila
authors.initials: AM
authors.lastname: Harouna
authors.affiliation: University Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. amorissanifolquet@hotmail.fr.|Paediatrics, Félix Houphouët Boigny University Hospital, Abidjan, Côte d'Ivoire. amorissanifolquet@hotmail.fr.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Amorissani-Folquet
authors.affiliation: Paediatrics, Yopougon University Hospital, Abidjan, Côte d'Ivoire. ebouatk@yahoo.fr.
authors.forename: François Tanoh
authors.initials: FT
authors.lastname: Eboua
authors.affiliation: Inserm U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. Sophie.Desmonde@isped.u-bordeaux2.fr.|University Bordeaux, ISPED, Centre Inserm, U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. Sophie.Desmonde@isped.u-bordeaux2.fr.
authors.forename: Sophie
authors.initials: S
authors.lastname: Desmonde
authors.affiliation: CePReF-enfant, ACONDA, Abidjan, Côte d'Ivoire. ngmariesyl@yahoo.ca.
authors.forename: Sylvie
authors.initials: S
authors.lastname: N'Gbeche
authors.affiliation: CePReF-enfant, ACONDA, Abidjan, Côte d'Ivoire.
authors.forename: Edmond Addi
authors.initials: EA
authors.lastname: Aka
authors.affiliation: CIRBA, Abidjan, Côte d'Ivoire. ziangbek@yahoo.fr.
authors.forename: Kouakou
authors.initials: K
authors.lastname: Kouadio
authors.affiliation: Centre MTCT-plus, Abidjan, Côte d'Ivoire. ousbkr@yahoo.fr.
authors.forename: Brou
authors.initials: B
authors.lastname: Kouacou
authors.affiliation: Inserm U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. Karen.Malateste@isped.u-bordeaux2.fr.|University Bordeaux, ISPED, Centre Inserm, U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. Karen.Malateste@isped.u-bordeaux2.fr.
authors.forename: Karen
authors.initials: K
authors.lastname: Malateste
authors.affiliation: Centre MTCT-plus, Abidjan, Côte d'Ivoire. abclarisse@yahoo.fr.
authors.forename: Clarisse
authors.initials: C
authors.lastname: Bosse-Amani
authors.affiliation: University Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.|Département de Dermatologie et d'Infectiologie, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire. ahuatchi@gmail.com.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ahuatchi Coffie
authors.affiliation: Inserm U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. Valeriane.Leroy@isped.u-bordeaux2.fr.|University Bordeaux, ISPED, Centre Inserm, U897 - Epidémiologie - Biostatistiques, F-33000, Bordeaux, France. Valeriane.Leroy@isped.u-bordeaux2.fr.
authors.forename: Valeriane
authors.initials: V
authors.lastname: Leroy
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D000962:Antimalarials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D007560:Cote d'Ivoire / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination