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Co-trimoxazole prophylaxis for HIV-infected infant

By Elham Elhshik | 09 May, 2017

Should we continue Co-trimoxazile prophylaxis for an 8 wks-old HIV-infected infant despite a normal CD4 level? As his weight is only 3.7 Kg while his VL is 9 million copies/ml and still not gaining much of weight since delivery, he just accessed HIV care and started receiving ARVs. If the answer is yes, for how long should we continue the prophylaxis?

Replies

 

Simon Collery Replied at 9:07 AM, 9 May 2017

Thank you for raising this question. I am not qualified to answer it myself, but I can tell you that I care for four young children who have been on co-trimoxozole for several years, regardless of VL and CD4, and without any continuing outward symptoms of infection.

Elham Elhshik Replied at 9:55 AM, 9 May 2017

Thank you for replying, I look for more evidence based answer. I tend to continue it as you said, but the care takers of the infant pay for the co-trimoxazole, and I'm not sure for how long will they be able to afford the medicine. Plus the infant already recives three different ARVs syrup as the co-formulation ARV is not available where I work, neither through the public nor the private sector. So telling the care giver that we will stop at least one syrup after some time will help to improve the adherence.

Simon Collery Replied at 10:16 AM, 9 May 2017

Yes, the caretakers pay, but the cost is low if you buy it in bulk, around 20 US cents for 100ml. All four children are on different regimens, only one is on a single tablet. The others are on different doses of several pills or a combination of syrup and dispersible tablets. It's surprising how many treatments are only available in solid, non-dispersible form, though, for very young children. These issues can also cause problems with adherence, as some children hate taking tablets, have trouble swallowing, etc. I have been told to keep the children on co-trimoxozole by their pediatrician, which is an option I have because of foreign funding, but most Tanzanians would not have easy access to a specialist, or would not be able to afford it. I have found that following the pediatrician's advice has worked out very well, which is why I continue to give them what was prescribed. But I would also like to know the answer to your question!

Sandra Shawarira-Bote Replied at 11:02 AM, 9 May 2017

The baby needs Cotrimoxazole prophylaxis now because he is at risk of getting opportunistic infections. According to the current WHO guidelines we give Cotimoxazole indefinitely esp in children and this as shown to be effective in protecting against OIs and malaria to which most of SSA is at risk. CD4 count is not very useful in children but CD4 % and a viral load of 9million would make me wary of higher risk of OIs and therefore the importance of Cotrimoxazole.

John Rek Replied at 11:14 AM, 9 May 2017

Alreast in Uganda, the guidelines are cotrim prophylaxis (against OIs) and
continue ART. I am not sure this has been changed by WHO yet.

Simon Collery Replied at 2:14 PM, 9 May 2017

Thanks for clarifying Sandra. So the cotrimoxazole is needed against OIs even though they should be taken care of by the ARVs? I thought it was generally given before the person was put on ARVs and perhaps for a while after. Is this different for children and infants?

edward shabani kateta Replied at 7:28 AM, 13 May 2017

HIV infants still need cotrimoxazol prophylaxis for OIs even when they are already in ARVs

Herbert Kadama Replied at 1:47 AM, 14 May 2017

Thanks for raising that issue. in Uganda the guidelines recommend the use
of cotrimoxazole prophylaxis for life irrespective of CD4 count or VL
because of its benefits of preventing OIs and Malaria.
I understand your concern about adherence but when the caregiver is well
counseled, then adherence will not be a big issue and cotrimoxazole is one
of the cheapest medicines especially if you are using generics.

lyasimana Ndaningina Replied at 2:17 AM, 14 May 2017

Expert opinion is required as cottimaxazole may cause marked hepatic damage or renal disease in such age

cheploen kiprop Replied at 2:18 AM, 14 May 2017

Yes. They should be put on it

Ahishakiye Alain Replied at 6:39 AM, 14 May 2017

Thank you All for your very interesting interventions. I have a question, How long will we keep cotrimoxazole prophylaxis after a negative serology in an 18-month-old child exposed to HIV during pregnancy?

Hileni Nangolo Replied at 8:10 AM, 14 May 2017

I concur, cotrimoxazole is good to prevent OIs and other diseases such as malaria.

Dr HT Nangolo

+264812033656

ilona sheehama Replied at 9:06 AM, 14 May 2017

I recommend ....

Reson Marima Replied at 11:04 AM, 14 May 2017

Hi

It depends on if they are breastfeeding or not..

If the infant is not breastfeeding you can stop it...if
breastfeeding...stop it 6 weeks after cessation of breastfeeding

Ahishakiye Alain Replied at 3:37 PM, 14 May 2017

Thank you Reson. We will continu for 6 weeks. Because we told to the mother to stop Breastfeeding the infant. Because we fund today that the HIV serology is n├ęgative.

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