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Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis
OBJECTIVE: To evaluate whether cotrimoxazole prophylaxis prevents common skin conditions in HIV-infected children. DESIGN: Open-label randomized controlled trial of continuing versus stopping daily cotrimoxazole (post-hoc analysis). SETTING: Three sites in Uganda and one in Zimbabwe. PARTICIPANTS: A...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976221/ https://www.ncbi.nlm.nih.gov/pubmed/27662556 http://dx.doi.org/10.1097/QAD.0000000000001264 |
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author | Prendergast, Andrew J. Bwakura-Dangarembizi, Mutsa Mugyenyi, Peter Lutaakome, Joseph Kekitiinwa, Adeodata Thomason, Margaret J. Gibb, Diana M. Walker, A. Sarah |
author_facet | Prendergast, Andrew J. Bwakura-Dangarembizi, Mutsa Mugyenyi, Peter Lutaakome, Joseph Kekitiinwa, Adeodata Thomason, Margaret J. Gibb, Diana M. Walker, A. Sarah |
author_sort | Prendergast, Andrew J. |
collection | PubMed |
description | OBJECTIVE: To evaluate whether cotrimoxazole prophylaxis prevents common skin conditions in HIV-infected children. DESIGN: Open-label randomized controlled trial of continuing versus stopping daily cotrimoxazole (post-hoc analysis). SETTING: Three sites in Uganda and one in Zimbabwe. PARTICIPANTS: 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. INTERVENTION: Continuing versus stopping daily cotrimoxazole. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: Long-term cotrimoxazole prophylaxis reduces common skin complaints, highlighting an additional benefit for long-term prophylaxis in sub-Saharan Africa. |
format | Online Article Text |
id | pubmed-5976221 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-59762212018-06-15 Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis Prendergast, Andrew J. Bwakura-Dangarembizi, Mutsa Mugyenyi, Peter Lutaakome, Joseph Kekitiinwa, Adeodata Thomason, Margaret J. Gibb, Diana M. Walker, A. Sarah AIDS Clinical Science: Concise Communications OBJECTIVE: To evaluate whether cotrimoxazole prophylaxis prevents common skin conditions in HIV-infected children. DESIGN: Open-label randomized controlled trial of continuing versus stopping daily cotrimoxazole (post-hoc analysis). SETTING: Three sites in Uganda and one in Zimbabwe. PARTICIPANTS: 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. INTERVENTION: Continuing versus stopping daily cotrimoxazole. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSION: Long-term cotrimoxazole prophylaxis reduces common skin complaints, highlighting an additional benefit for long-term prophylaxis in sub-Saharan Africa. Lippincott Williams & Wilkins 2016-11-28 2016-11-08 /pmc/articles/PMC5976221/ /pubmed/27662556 http://dx.doi.org/10.1097/QAD.0000000000001264 Text en Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0, where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | Clinical Science: Concise Communications Prendergast, Andrew J. Bwakura-Dangarembizi, Mutsa Mugyenyi, Peter Lutaakome, Joseph Kekitiinwa, Adeodata Thomason, Margaret J. Gibb, Diana M. Walker, A. Sarah Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis |
title | Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis |
title_full | Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis |
title_fullStr | Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis |
title_full_unstemmed | Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis |
title_short | Reduced bacterial skin infections in HIV-infected African children randomized to long-term cotrimoxazole prophylaxis |
title_sort | reduced bacterial skin infections in hiv-infected african children randomized to long-term cotrimoxazole prophylaxis |
topic | Clinical Science: Concise Communications |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976221/ https://www.ncbi.nlm.nih.gov/pubmed/27662556 http://dx.doi.org/10.1097/QAD.0000000000001264 |
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