Browsing by Author "Coovadia, Hoosen"

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    The Evidence For Using Conjugate Vaccines To Protect HIV-Infected Children Against Pneumococcal Disease
    (The Lancet infectious diseases, 2008) Bliss, Sandra J.; O’Brien, Katherine L.; Janoff, Edward N.; Cotton, Mark F.; Musoke, Philippa; Coovadia, Hoosen; Levine, Orin S.
    Pneumococcal conjugate vaccines (PCVs) are a potentially useful complement to existing treatment strategies in HIV-infected children, for whom pneumococcal infections are common and serious. This Review summarises available data on the burden of pneumococcal disease and the safety and efficacy of PCVs in HIV-infected children. The data demonstrate that children with HIV have significantly increased risk of pneumococcal disease compared with uninfected children; the serotypes included in currently licensed or near-licensure conjugate vaccines include most serotypes that cause invasive pneumococcal disease (IPD) in HIV-infected children and adults; PCVs provide substantial protection against IPD and clinical pneumonia when given to HIV-infected infants; and HIV-infected adults gain an indirect benefit when children in the community are vaccinated. PCV should be considered as an important intervention for improving the lives of HIV-infected children.
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    Extended prophylaxis with nevirapine and cotrimoxazole among HIV-exposed uninfected infants is well tolerated
    (AIDS (London, England), 2012) Aizire, Jim; Fowler, Mary Glenn; Wang, Jing; Shetty, Avinash K.; Chibanda, Lynda Stranix; Kamateeka, Moreen; Brown, Elizabeth R.; Bolton, Steve G.; Musoke, Philippa M.; Coovadia, Hoosen
    Nevirapine and cotrimoxazole are associated with hematologic toxicities and skin-rash. Safety of their concurrent use for prophylaxis over extended periods among HIV-exposed uninfected infants has not been previously assessed.Secondary data analysis of the ‘HIV Prevention Trials Network-046 protocol’ (version 2.0), a phase-III, randomized, placebo-controlled trial that assessed efficacy and safety of nevirapine prophylaxis against breast milk transmission of HIV-1.Trial infants received 6-month study nevirapine/placebo, and standard-of-care peripartum single-dose nevirapine+/– zidovudine ‘tail’, and cotrimoxazole prophylaxis from 6 weeks through breastfeeding cessation. Adverse events were monitored using United States Division of AIDS Toxicity Tables (2004). Risk of neutropenia, anemia and skin-rash in the cotrimoxazole+nevirapine and the cotrimoxazole+placebo groups were compared using negative-binomial regression.Incidence of neutropenia and/or anemia, and skin-rash was highest during the first 6 weeks of life and declined, thereafter, regardless of study group. Time to first adverse event after 6 weeks was similar in cotrimoxazole+nevirapine and cotrimoxazole+placebo groups: hazard ratio (95% confidence interval) was 1.26 (0.96–1.66) for neutropenia and/or anemia (all grades), 1.27 (0.80–2.03) for neutropenia and/or anemia (grade ≥3) and 1.16 (0.46–2.90) for skin-rash (grade ≥2). There were no statistically significant differences in immediate (6 weeks–6 months) and long-term (6–12 months) adverse event risk among infants on cotrimoxazole+nevirapine versus cotrimoxazole+placebo.Extended nevirapine and cotrimoxazole prophylaxis through 6 months of age among HIV-exposed uninfected infants did not appear to increase the immediate or long-term risk of neutropenia, anemia or skin-rash. Concurrent use beyond 6 months, however, needs to be evaluated.
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    Handbook on Pædiatric AIDS in Africa by the African Network for the Care of Children Affected by AIDS
    (African Network for the Care of Children Affected by AIDS (ANECCA)., 2004) Tindyebwa, Denis; Kayita, Janet; Musoke, Philippa; Eley, Brian; Nduati, Ruth; Coovadia, Hoosen; Bobart, Raziya; Mbori-Ngacha, Dorothy; Kieffer, Mary Pat
    HIV/AIDS is a major cause of infant and childhood mortality and morbidity in Africa. In children under five years of age, HIV/AIDS now accounts for 7.7% of mortality worldwide. AIDS already accounts for a rise of more than 19% in infant mortality and a 36% rise in underfive mortality. Together with factors such as declining immunisation, HIV/AIDS is threatening recent gains in infant and child survival and health. Yet, for the most part, HIV infection in children is preventable. In industrialised countries in North America and Europe, paediatric HIV infection has largely been controlled. In these settings, HIV testing as part of routine antenatal care, combinations of antiretroviral (ARV) drug regimens, elective caesarean section, and complete avoidance of breast-feeding have translated into mother-to-child transmission (MTCT) rates of less than 2%. In Africa, on the other hand, high rates of maternal HIV infection, high birth rates, lack of access to currently available and feasible interventions, and the widespread practice of prolonged breast-feeding translate into a high burden of paediatric HIV disease. The transmission risk for a child born to an HIV-infected mother in an African setting without interventions for prevention of mother-to-child transmission (PMTCT) is about 30–40%. The other 60–70% of children, although not HIV-infected, still have a 2- to 5-fold risk of mortality as a direct consequence of the mother’s HIV disease, when compared to children born to uninfected mothers.
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    Sub-Saharan Africa’s Mothers, Newborns, and Children: Where and Why Do They Die?
    (PLoS medicine, 2010) Kinney, Mary V.; Kerber, Kate J.; Black, Robert E.; Cohen, Barney; Nkrumah, Francis; Coovadia, Hoosen; Nampala, Paul Michael; Lawn, Joy E.
    This paper is part of a PLoS Medicine series on maternal, newborn, and child health in Africa. Nearly 4.7 million mothers, newborns, and children die each year in sub-Saharan Africa: 265,000 mothers die due to complications of pregnancy and childbirth [1]; 1,208,000 babies die before they reach one month of age ; and 3,192,000 children, who survived their first month of life, die before their fifth birthday [1]. This toll of more than 13,000 deaths per day accounts for half of the world’s maternal and child deaths. In addition, an estimated 880,000 babies are stillborn in sub- Saharan Africa and remain invisible on the policy agenda. With only five years left to achieve the United Nation’s Millennium Development Goals (MDGs) for maternal and child health, most African countries in the region are currently unlikely to meet their MDG targets. Since time is short for achieving success, a critical understanding of where and why these deaths occur, and of strategic, data-based prioritization of interventions, are essential to accelerate progress.