Effect of HIV-1 infection on malaria treatment outcome in Ugandan patients.
BACKGROUND
Malaria and HIV-1 infection cause significant morbidity and mortality in sub-Saharan Africa. HIV-1 increases risk for malaria with the risk increasing as immunity declines. The effect of HIV-1 infection on antimalarial treatment outcome is still inconclusive.


OBJECTIVE
To compare antimalarial treatment outcome among HIV-1 positive and negative patients with acute uncomplicated falciparum malaria treated with chloroquine plus sulfadoxine-pyrimethamine (CQ+SP).


METHODS
Ninety eight HIV-1 positive patients aged 18 months or older with acute uncomplicated falciparum malaria were treated with CQ+SP and followed for 28 days to monitor outcome. Treatment outcome of HIV-1 positive patients was compared to that of 193 HIV-1 negative historical controls. The primary study outcome for both groups was treatment failure.


RESULTS
HIV-1 positive patients older than 5 years of age were less likely to have treatment failure compared to HIV-1 negative patients in the same age group (RR 0.59 95% CI 0.4-0.8, p < 0.001) and HIV-1 positive patients on routine cotrimoxazole prophylaxis were less likely to have treatment failure following CQ+SP treatment compared to HIV negative patients (RR 0.6 95% CI 0.43-0.92, p = 0.006). There was no difference in treatment outcome according to HIV-1 status for children younger than 5 years of age.


CONCLUSIONS
Adherence to cotrimoxazole prophylaxis should be reinforced in HIV positive patients and it should be reassessed if these patients present with acute episodes of malaria.
Byakika-Kibwika
Pauline
P
Makerere University Medical School, Department of Medicine, Kampala, Uganda. pbyakika@gmail.com
Ddumba
Edward
E
Kamya
Moses
M
D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000503:physiopathology*; D015497:HIV-1; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D017063:Outcome Assessment, Health Care; D017211:Treatment Failure; D014454:Uganda