Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis.
To evaluate whether cotrimoxazole prophylaxis prevents common skin conditions in HIV-infected children.



Open-label randomized controlled trial of continuing versus stopping daily cotrimoxazole (post-hoc analysis).



Three sites in Uganda and one in Zimbabwe.



A total of 758 children aged more than 3 years receiving antiretroviral therapy (ART) for more than 96 weeks in the ARROW trial were randomized to stop (n = 382) or continue (n = 376) cotrimoxazole after median (interquartile range) 2.1(1.8, 2.2) years on ART.



Continuing versus stopping daily cotrimoxazole.



Nurses screened for signs/symptoms at 6-week visits. This was a secondary analysis of ARROW trial data, with skin complaints categorized blind to randomization as bacterial, fungal, or viral infections; dermatitis; pruritic papular eruptions (PPEs); or others (blisters, desquamation, ulcers, and urticaria). Proportions ever reporting each skin complaint were compared across randomized groups using logistic regression.



At randomization, median (interquartile range) age was 7 (4, 11) years and CD4 was 33% (26, 39); 73% had WHO stage 3/4 disease. Fewer children continuing cotrimoxazole reported bacterial skin infections over median 2 years follow-up (15 versus 33%, respectively; P < 0.001), with similar trends for PPE (P = 0.06) and other skin complaints (P = 0.11), but not for fungal (P = 0.45) or viral (P = 0.23) infections or dermatitis (P = 1.0). Bacterial skin infections were also reported at significantly fewer clinic visits (1.2 versus 3.0%, P < 0.001). Independent of cotrimoxazole, bacterial skin infections were more common in children aged 6-8 years, with current CD4 cell count less than 500 cells/μl, WHO stage 3/4, less time on ART, and lower socio-economic status.



Long-term cotrimoxazole prophylaxis reduces common skin complaints, highlighting an additional benefit for long-term prophylaxis in sub-Saharan Africa.
aQueen Mary University of London bMRC Clinical Trials Unit at UCL, London, UK cUniversity of Zimbabwe, Harare, Zimbabwe dJoint Clinical Research Centre, Kampala, Uganda eMedical Research Council/Uganda Virus Research Institute Uganda Research Unit on AIDS, Entebbe fPaediatric Infectious Diseases Clinic/Baylor - Uganda, Mulago Hospital, Kampala, Uganda.
Andrew J
AJ
Prendergast
Mutsa
M
Bwakura-Dangarembizi
Peter
P
Mugyenyi
Joseph
J
Lutaakome
Adeodata
A
Kekitiinwa
Margaret J
MJ
Thomason
Diana M
DM
Gibb
A Sarah
AS
Walker
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D017192:Skin Diseases, Bacterial / Q000453:epidemiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*; D014454:Uganda / Q000453:epidemiology; D015030:Zimbabwe / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
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