The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review
Background: HIV-related opportunistic infections like <i>Pneumocystis jirovecii</i> Pneumonia (PCP) remain a major contributor to child morbidity and mortality globally. PCP accounts for over 60% of AIDS in the first year of life and is responsible for a third of AIDS in children globall...
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2025-02-01
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| author | Anthony O. Agwu Chinedu Ogbonnia Egwu Albert Egwu Okorocha Ifeanyi Enyanwuma Cyril C. Amadi Evaezi Okpokoro Francis Patrick Akpabio Chukwuemeka Ogbonnaya Aguwa Donatus Onwu Onyedikachi Nwokoro |
| author_facet | Anthony O. Agwu Chinedu Ogbonnia Egwu Albert Egwu Okorocha Ifeanyi Enyanwuma Cyril C. Amadi Evaezi Okpokoro Francis Patrick Akpabio Chukwuemeka Ogbonnaya Aguwa Donatus Onwu Onyedikachi Nwokoro |
| author_sort | Anthony O. Agwu |
| collection | DOAJ |
| description | Background: HIV-related opportunistic infections like <i>Pneumocystis jirovecii</i> Pneumonia (PCP) remain a major contributor to child morbidity and mortality globally. PCP accounts for over 60% of AIDS in the first year of life and is responsible for a third of AIDS in children globally. Cotrimoxazole prophylaxis, which is an intervention directed towards tackling this burden, has not attained remarkable coverage despite advocacy towards scale-up. This work was therefore aimed at evaluating the efficacy of cotrimoxazole in the prevention of PCP among children exposed to and infected with HIV by carrying out a systematic review. Methods: Key scientific databases were searched for primary studies not older than 15 years old without language restrictions. Randomized Control Trials (RCTs) and Cohorts comparing the effectiveness of cotrimoxazole versus placebo in the prevention of PCP among children (<17 years) exposed to and infected with HIV were selected. Studies with a duration of follow-up not less than 3 months long were included. A meta-analysis was conducted on RevMan 5.3 statistical application software following data extraction, and the data quality and risk of bias were also assessed. Exactly Ten (10) studies were selected and analyzed. Findings: It was observed that cotrimoxazole had beneficial effects in terms of a reduction in mortality among HIV-exposed and infected children, as 72 fewer children in 1000 (based on an absolute 95% CI) will die as a result of cotrimoxazole compared to a placebo. Cotrimoxazole also significantly reduces hospital admissions (<i>p</i>-value of 0.008). The adverse events associated with cotrimoxazole are comparable to a placebo when co-administered with ARTS (<i>p</i> = 0.90), which did not impact adherence. Conclusion: The benefits of cotrimoxazole prophylaxis far outweigh its risks. Therefore, scaling up the intervention is recommended as a prophylactic for wider coverage, especially in resource-limited settings. |
| format | Article |
| id | doaj-art-a1b2dfb88dec47de9e8e96b72c60fcf3 |
| institution | OA Journals |
| issn | 2673-3986 |
| language | English |
| publishDate | 2025-02-01 |
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| series | Epidemiologia |
| spelling | doaj-art-a1b2dfb88dec47de9e8e96b72c60fcf32025-08-20T02:11:14ZengMDPI AGEpidemiologia2673-39862025-02-0161810.3390/epidemiologia6010008The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic ReviewAnthony O. Agwu0Chinedu Ogbonnia Egwu1Albert Egwu Okorocha2Ifeanyi Enyanwuma3Cyril C. Amadi4Evaezi Okpokoro5Francis Patrick Akpabio6Chukwuemeka Ogbonnaya Aguwa7Donatus Onwu8Onyedikachi Nwokoro9Department of Public Health, University of Chester, Chester CH1 4BJ, UKMedical Biochemistry Department, College of Medicine, Alex-Ekwueme Federal University Ndufu-Alike, P.M.B. 1010, Ikwo 482131, NigeriaPhysiology Department, College of Medicine, Alex-Ekwueme Federal University Ndufu-Alike, P.M.B. 1010, Ikwo 482131, NigeriaSurgery Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki 480282, NigeriaMedical Biochemistry Department, College of Medicine, Alex-Ekwueme Federal University Ndufu-Alike, P.M.B. 1010, Ikwo 482131, NigeriaInternational Research Center of Excellence, Institute of Human Virology, Abuja 900246, NigeriaGarki Hospital, Tafawa Balewa Way, Area 8, Garki, Abuja 900103, NigeriaOvercomer Jubilee Hospital, Umuahia 440221, NigeriaOrthopedics Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki 480282, NigeriaSurgery Department, Alex Ekwueme Federal University Teaching Hospital, Abakaliki 480282, NigeriaBackground: HIV-related opportunistic infections like <i>Pneumocystis jirovecii</i> Pneumonia (PCP) remain a major contributor to child morbidity and mortality globally. PCP accounts for over 60% of AIDS in the first year of life and is responsible for a third of AIDS in children globally. Cotrimoxazole prophylaxis, which is an intervention directed towards tackling this burden, has not attained remarkable coverage despite advocacy towards scale-up. This work was therefore aimed at evaluating the efficacy of cotrimoxazole in the prevention of PCP among children exposed to and infected with HIV by carrying out a systematic review. Methods: Key scientific databases were searched for primary studies not older than 15 years old without language restrictions. Randomized Control Trials (RCTs) and Cohorts comparing the effectiveness of cotrimoxazole versus placebo in the prevention of PCP among children (<17 years) exposed to and infected with HIV were selected. Studies with a duration of follow-up not less than 3 months long were included. A meta-analysis was conducted on RevMan 5.3 statistical application software following data extraction, and the data quality and risk of bias were also assessed. Exactly Ten (10) studies were selected and analyzed. Findings: It was observed that cotrimoxazole had beneficial effects in terms of a reduction in mortality among HIV-exposed and infected children, as 72 fewer children in 1000 (based on an absolute 95% CI) will die as a result of cotrimoxazole compared to a placebo. Cotrimoxazole also significantly reduces hospital admissions (<i>p</i>-value of 0.008). The adverse events associated with cotrimoxazole are comparable to a placebo when co-administered with ARTS (<i>p</i> = 0.90), which did not impact adherence. Conclusion: The benefits of cotrimoxazole prophylaxis far outweigh its risks. Therefore, scaling up the intervention is recommended as a prophylactic for wider coverage, especially in resource-limited settings.https://www.mdpi.com/2673-3986/6/1/8HIV-related opportunistic infectionspneumoniacotrimoxazoleprevention and efficacy |
| spellingShingle | Anthony O. Agwu Chinedu Ogbonnia Egwu Albert Egwu Okorocha Ifeanyi Enyanwuma Cyril C. Amadi Evaezi Okpokoro Francis Patrick Akpabio Chukwuemeka Ogbonnaya Aguwa Donatus Onwu Onyedikachi Nwokoro The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review Epidemiologia HIV-related opportunistic infections pneumonia cotrimoxazole prevention and efficacy |
| title | The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review |
| title_full | The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review |
| title_fullStr | The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review |
| title_full_unstemmed | The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review |
| title_short | The Efficacy of Cotrimoxazole for the Prevention of <i>Pneumocystis jirovecii</i> Pneumonia Among HIV-Exposed and Infected Children: A Systematic Review |
| title_sort | efficacy of cotrimoxazole for the prevention of i pneumocystis jirovecii i pneumonia among hiv exposed and infected children a systematic review |
| topic | HIV-related opportunistic infections pneumonia cotrimoxazole prevention and efficacy |
| url | https://www.mdpi.com/2673-3986/6/1/8 |
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