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Infectious Diseases in Obstetrics and Gynecology
Volume 2013, Article ID 340702, 8 pages
Research Article

The Effect of Cotrimoxazole Prophylactic Treatment on Malaria, Birth Outcomes, and Postpartum CD4 Count in HIV-Infected Women

1University of North Carolina Gillings School of Global Public Health, 2104 McGavran-Greenberg Hall, 135 Dauer Drive, CB 7435, Chapel Hill, NC 27599-7435, USA
2UNC Project-Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
3University of North Carolina Gillings School of Global Public Health, 3107-E McGavran-Greenberg Hall, Chapel Hill, NC 27599, USA
4University of North Carolina Gillings School of Global Public Health, 2104 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7435, USA
5US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
6The Ohio State University, N1145 Doan Hall, 410 W. 10th Avenue Columbus, OH 43210, USA
7Epidemiology and Biostatistics Division, School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
8Division of Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Chapel Hill, NC 27599-7030, USA

Received 19 June 2013; Accepted 7 October 2013

Academic Editor: Ann Duerr

Copyright © 2013 Anna Dow et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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/μL, 95% CI: −125.2, −30.1) and not receiving antiretrovirals (−33.7 cells/μL, 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.