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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effectiveness of co-trimoxazole to prevent plasmodium falciparum malaria in HIV-positive pregnant women in sub-saharan Africa: An open-label, randomized controlled trial
Clinical Infectious Diseases, Volume 58, No. 5, Year 2014
Notification
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Description
Background. Human immunodeficiency virus (HIV) and malaria during pregnancy cause substantial perinatal mortality. As co-trimoxazole (CMX) protects children and HIV-positive adults against malaria, we compared the effectiveness of daily CMX with sulfadoxine-pyrimethamine intermittent preventive treatment (IPT-SP) on malaria risk in HIV-positive pregnant women in a Plasmodium falciparum-endemic African area.Methods. From January 2009 to April 2011, we included in a randomized noninferiority trial all HIV type 1-infected pregnant women (≤28 weeks' gestation, CD4 count ≥200 cells/μL, hemoglobin level ≥7 g/L) in 19 health centers in Togo. Women were randomly assigned to daily 800 mg/160 mg CMX, or IPT-SP. The primary outcome was the proportion of malaria-free pregnancies. Other outcomes included malaria incidence, parasitemia, placental malaria, anemia, and infants' birth weight.Results. Of 264 women randomly assigned to the CMX or IPT-SP group, 126 of 132 and 124 of 132, respectively, were included in the analysis. There were 33 confirmed cases of clinical malaria among 31 women in the CMX group, and 19 among 19 women in the IPT-SP group. Ninety-five of 126 (75.4%) women in the CMX group and 105 of 124 (84.7%) in the IPT-SP group remained malaria-free during their pregnancy (difference, 9.3%; 95% confidence interval [CI],-.53 to 19.1, not meeting the predefined noninferiority criterion). The incidence rate in intention-to-treat analysis was 108.8 malaria episodes per 100 person-years in CMX (95% CI, 105.4-112.2) and 90.1 in IPT-SP (95% CI, 86.8-93.4) (not significant). Prevalence of parasitemia was 16.7% in the CMX group vs 28% in the IPT-SP group (P =. 02). Histology revealed 20.3% placental malaria in the CMX group vs 24.6% in the IPT-SP group (not significant). Grade 3-4 anemia was more frequent in the CMX group (10% vs 4%; P =. 008). No pregnant women died. Median birth weight was similar.Conclusions. Daily CMX was not noninferior to IPT-SP for preventing maternal malaria but safe and at least similar regarding parasitemia or placental malaria and birth outcomes. © 2013 The Author.
Authors & Co-Authors
Klement, Elise
France, Briis-sous-forges
Centre Hospitalier de Bligny
Pitché, Palokinam Vincent
Togo, Lome
Centre Hospitalo-universitaire so
Kendjo, Éric
France, Paris
Hôpital Universitaire Pitié Salpêtrière
Singo-Tokofaï, Assétina
Togo, Lome
Centre Hospitalo-universitaire so
D'Alméida, Stéphane
Togo, Lome
Centre Hospitalo-universitaire so
Akouete, Folly
Unknown Affiliation
Akpaloo, Yawo
France
Centre Hospitalier Préfectoral
Tossa, Kokou Robert
Togo, Lome
Programme National de Lutte Contre le Paludisme Pnlp
Prince-Agbodjan, Serge
Unknown Affiliation
Patassi, Akouda Akessiwe
Togo, Lome
Centre Hospitalo-universitaire so
Caumes, Éric
France, Paris
Hôpital Universitaire Pitié Salpêtrière
Statistics
Citations: 34
Authors: 11
Affiliations: 5
Identifiers
Doi:
10.1093/cid/cit806
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative
Study Locations
Togo
Participants Gender
Female