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Impact of cotrimoxazole prophylaxis on the health of breast-fed, HIV-exposed, HIV-negative infants in a resource-limited setting

Coutsoudis, Annaa; Kindra, Gurpreeta; Esterhuizen, Tonyab

doi: 10.1097/QAD.0b013e32834ad699
Research Letter

WHO guidelines recommend cotrimoxazole prophylaxis (CTXP) in all HIV-exposed negative infants who are still breastfeeding. This is based on the evidence of efficacy in HIV-infected infants, but there is no evidence of benefit in HIV-negative, breast-fed infants. We assessed the impact of CTXP on diarrhoeal and respiratory morbidity in breast-fed, HIV-exposed negative infants in a community programme. CTXP for more than 60 days showed no consistent evidence of benefit for incidence of lower respiratory tract infection [incidence rate ratio (IRR) 0.71, 95% confidence interval (CI) 0.39–1.26; P = 0.241] but an increased incidence of diarrhoea (IRR = 1.38, 95% CI 0.98–1.94; P = 0.065). The guidelines should be reconsidered by conducting a randomized control trial.

aDepartment Paediatrics and Child Health

bProgramme of Biostatistics, Research Ethics and Medical Law, School of Family and Public Health, University of KwaZulu-Natal, Durban, South Africa.

Correspondence to Professor Anna Coutsoudis, PhD, Department Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa. Tel: +27 31 2604489; e-mail:

Received 24 June, 2011

Accepted 12 July, 2011

© 2011 Lippincott Williams & Wilkins, Inc.