Malaria treatment efficacy among people living with HIV: the role of host and parasite factors.
Identification of an effect of HIV-associated immunosuppression on response to antimalarial therapy would help guide management of malaria infection in areas of high HIV prevalence. Therefore, we conducted an observational study of people living with HIV infection in Blantyre, Malawi. Participants who developed malaria were treated with sulfadoxine-pyrimethamine (SP) and followed for 28 days. Molecular markers for SP resistance were measured. One hundred seventy-eight episodes of malaria were assessed. The 28-day cumulative treatment failure rate was 29.1%. In univariate analysis, CD4 cell count was not associated with treatment failure (hazard ratio 0.6, 95% confidence interval 0.3-1.2). Among children, the risk of treatment failure increased with infection with SP-resistant parasites and anemia. Decreased CD4 cell count was not associated with impaired response to antimalarial therapy or diminished ability to clear SP-resistant parasites, suggesting that acquired immunity to malaria is retained in the face of HIV-associated immunosuppression.
Laufer
Miriam K
MK
Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. mlaufer@medicine.umaryland.edu
van Oosterhout
Joep J G
JJ
Thesing
Phillip C
PC
Dzinjalamala
Fraction K
FK
Hsi
Teresa
T
Beraho
Lorraine
L
Graham
Stephen M
SM
Taylor
Terrie E
TE
Plowe
Christopher V
CV
D000293:Adolescent; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004338:Drug Combinations; D018432:Drug Resistance, Multiple; D019353:Endemic Diseases; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000469:parasitology*; D006801:Humans; D016867:Immunocompromised Host; D008137:Longitudinal Studies; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D018512:Parasitemia / Q000276:immunology / Q000469:parasitology / Q000821:virology; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D016896:Treatment Outcome
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine