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Antenatal cotrimoxazole prophylaxis improves pregnancy outcomes in HIV-infected women with CD4 counts below 200 cells per microliter, according to a report in the December 1st issue of The Journal of Infectious Diseases.
"Our data suggest that in addition to benefits for maternal health, use of cotrimoxazole during pregnancy may have beneficial consequences for infants, too, reducing rates of low birth weight, preterm delivery, and neonatal mortality," Dr. Louise Kuhn from Columbia University, New York told Reuters Health.
Dr. Kuhn and colleagues investigated whether co-trimoxazole begun during pregnancy would influence birth outcomes in 255 HIV-infected women with low CD4 cell counts who had previously given birth to live, singleton infants. The outcomes of these pregnancies were compared with that of a subsequent pregnancy in which cotrimoxazole prophylaxis was used.
Cotrimoxazole prophylaxis was associated with significant reductions in the percentage of preterm births, clinical chorioamnionitis, and neonatal mortality, the authors report, as well as a trend toward a 115-gram increase in mean birth weight.
The beneficial effects of cotrimoxazole prophylaxis persisted after adjustment for hemoglobin level, severe poverty, maternal education, and gestational age at enrollment, according to a multiple logistic regression model.
Birth outcomes among women with higher CD4 cell counts did not change consistently after the introduction of cotrimoxazole prophylaxis, the researchers note. However, there was a nonsignificant trend toward reduced maternal mortality and hospital admissions.
"HIV-infected women with low CD4 counts are at high risk of having low birth weight babies, giving birth prematurely, and experiencing high rates of neonatal mortality," Dr. Kuhn said. "Thus, the infants of HIV-infected women are placed in double jeopardy -- both for HIV infection and for other high-risk outcomes that place them at risk of death. Co-trimoxazole is recommended forr all immunosuppressed HIV-infected persons because of the demonstrated benefit of prophylaxis on morbidity and mortality."
"These results are exciting, because an intervention known to be of benefit for maternal health appears to benefit infant outcomes as well," write Dr. D. Heather Watts and Dr. Lynne M. Mofenson from National Institute of Child Health and Human Development, Bethesda, Maryland in a related commentary.
"Only with an approach that combines antiretroviral therapy and opportunistic-infection prophylaxis, along with continued therapy being available for women after delivery, will maximum benefit for maternal survival and, ultimately, infant survival be obtained," the editorial concludes. "Until prevention of HIV infection in women can be achieved, efforts must be intensified to identify and optimally treat HIV-infected women and their families."
"We think that it would be useful to investigate if the beneficial effects of cotrimoxazole on neonatal outcomes extend to HIV-infected pregnant women started on HAART during pregnancy," Dr. Kuhn added. "We also think it may be useful to investigate if beneficial effects might extend to women with higher CD4 counts and even to HIV uninfected women in communities at high risk for poor neonatal outcomes."
