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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
High risk of neutropenia in HIV-infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda
Clinical Infectious Diseases, Volume 46, No. 7, Year 2008
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Description
Background. Artemisinin-based combination therapies are rapidly being adopted for the treatment of malaria in Africa; however, there are limited data on their safety and efficacy among human immunodeficiency virus (HIV)-infected populations. Methods. We compared malaria treatment outcomes between cohorts of HIV-infected and HIV-uninfected children in Uganda who were observed for 18 and 29 months, respectively. Malaria was treated with artesunate plus amodiaquine, and outcomes were assessed using standardized guidelines. HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis and antiretroviral therapy in accordance with current guidelines. Results. Twenty-six HIV-infected participants experiencing 35 episodes of malaria and 134 HIV-uninfected children experiencing 258 episodes of malaria were included in the study. Twelve HIV-infected children were receiving antiretroviral therapy, 11 of whom were receiving zidovudine. Malaria treatment was highly efficacious in both the HIV-infected and HIV-uninfected cohorts (28-day risk of recrudescence, 0% and 3.6%, respectively); however, there was a trend towards increased risk of recurrent malaria among the HIV-uninfected children (2.9% vs. 13.2%; P = .08). Importantly, the risk of neutropenia 14 days after initiation of treatment with artesunate plus amodiaquine was higher among HIV-infected children than among HIV-uninfected children (45% vs. 6%; P < .001). The severity of all episodes of neutropenia in HIV-uninfected children was mild to moderate, and 16% of episodes of neutropenia in the HIV-infected cohort were severe or life-threatening (neutrophil count, <750 cells/mm3). In the HIV-infected cohort, the risk of neutropenia was significantly higher among children who received antiretroviral therapy than among those who did not receive antiretroviral therapy (75% vs. 26%; P = .001). Conclusions. Artesunate plus amodiaquine was highly efficacious for malaria treatment in HIV-infected children but was associated with a high risk of neutropenia, especially in the context of concurrent antiretroviral use. Our findings highlight an urgent need for evaluation of alternative antimalarial therapies for HIV-infected individuals. © 2008 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Gasasira, Anne F.
Unknown Affiliation
Kamya, Moses Robert K.
Unknown Affiliation
Achan, Jane
Unknown Affiliation
Mebrahtu, Tsedal
Unknown Affiliation
Kalyango, Joan Nakayaga
Unknown Affiliation
Ruel, Theodore D.
Unknown Affiliation
Charlebois, Edwin D.
Unknown Affiliation
Staedke, Sarah G.
Unknown Affiliation
Kekitiinwa, Adeodata R.
Unknown Affiliation
Rosenthal, Philip Jon
Unknown Affiliation
Havlir, Diane V.
Unknown Affiliation
Dorsey, Grant M.
Unknown Affiliation
Statistics
Citations: 78
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1086/529192
ISSN:
10584838
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cohort Study
Study Locations
Uganda