David C Boettiger1, Dina Muktiarti2, Nia Kurniati2, Khanh H Truong3, Suneeta Saghayam4, Penh Sun Ly5, Rawiwan Hansudewechakul6, Lam Van Nguyen7, Viet Chau Do8, Tavitiya Sudjaritruk9, Pagakrong Lumbiganon10, Kulkanya Chokephaibulkit11, Torsak Bunupuradah12, Nik Khairulddin Nik Yusoff13, Dewi Kumara Wati14, Kamarul Azahar Mohd Razali15, Moy Siew Fong16, Revathy A Nallusamy17, Annette H Sohn18, Azar Kariminia1. 1. The Kirby Institute, University of New South Wales, Sydney, Australia. 2. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. 3. Children's Hospital 1, Ho Chi Minh City, Vietnam. 4. Y.R. Gaitonde Center for AIDS Research and Education Medical Centre, Chennai, India. 5. National Centre for HIV/AIDS, Dermatology, and Sexually Transmitted Diseases, Phnom Penh, Cambodia. 6. Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand. 7. National Hospital of Pediatrics, Hanoi. 8. Children's Hospital 2, Ho Chi Minh City, Vietnam. 9. Department of Pediatrics, Faculty of Medicine, Chiang Mai University and Research Institute for Health Sciences, Chiang Mai. 10. Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen. 11. Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok. 12. HIV Netherlands Australia Thailand Research Collaboration, Thai Red Cross AIDS Research Centre, Bangkok, Thailand. 13. Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. 14. Sanglah Hospital, Udayana University, Bali, Indonesia. 15. Pediatric Institute, Hospital Kuala Lumpur, Kuala Lumpur. 16. Hospital Likas, Kota Kinabalu. 17. Penang Hospital, Penang, Malaysia. 18. TREAT Asia/amfAR-Foundation for AIDS Research, Bangkok, Thailand.
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.
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.
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