title: Two-dose versus monthly intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine in HIV-seropositive pregnant Zambian women.
abstract: BACKGROUND
  Intermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains controversial.
  
  
  METHODS
  We conducted a randomized, double-blind, placebo-controlled study of IPTp comparing the standard 2-dose sulfadoxine-pyrimethamine (SP) regimen with monthly IPTp among a cohort of HIV-positive pregnant Zambian women. Primary outcomes included placental malaria (by smear and histology) and maternal peripheral parasitemia at delivery.
  
  
  RESULTS
  There were no differences between monthly IPTp (n=224) and standard IPTp (n=232) in placental malaria by histopathology (26% vs. 29%; relative risk [RR], 0.90 [95% confidence interval {CI}, 0.64-1.26]) or placental parasitemia (2% vs. 4%; RR, 0.55 [95% CI, 0.17-1.79]). There also were no differences in maternal anemia, stillbirths, preterm delivery, LBW, or all-cause mortality of infants at 6 weeks.
  
  
  CONCLUSIONS
  In an area of mesoendemicity in Zambia, monthly SP IPTp was not more efficacious than the standard 2-dose regimen for the prevention of placental malaria or adverse birth outcomes. IPTp policy recommendations need to take into account local malaria transmission patterns and the prevalence of HIV.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00270530.
authors.affiliation: Center for International Health and Development, Boston University School of Public Health, Boston, MA 02118, USA. dhamer@bu.edu
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
authors.forename: Victor
authors.initials: V
authors.lastname: Mwanakasale
authors.forename: William B
authors.initials: WB
authors.lastname: Macleod
authors.forename: Victor
authors.initials: V
authors.lastname: Chalwe
authors.forename: Doreen
authors.initials: D
authors.lastname: Mukwamataba
authors.forename: Davies
authors.initials: D
authors.lastname: Champo
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mwananyanda
authors.forename: Roma
authors.initials: R
authors.lastname: Chilengi
authors.forename: Lwambwa
authors.initials: L
authors.lastname: Mubikayi
authors.forename: Chikuli Kabika
authors.initials: CK
authors.lastname: Mulele
authors.forename: Modest
authors.initials: M
authors.lastname: Mulenga
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gill
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D000328:Adult; D000740:Anemia / Q000139:chemically induced; D000962:Antimalarials / Q000008:administration & dosage* / Q000009:adverse effects*; D001724:Birth Weight; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005312:Fetal Blood / Q000469:parasitology; D006679:HIV Seropositivity; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000453:epidemiology / Q000517:prevention & control*; D016017:Odds Ratio; D018512:Parasitemia / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D010920:Placenta / Q000469:parasitology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000469:parasitology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D011739:Pyrimethamine / Q000008:administration & dosage* / Q000009:adverse effects*; D012307:Risk Factors; D013413:Sulfadoxine / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome; D015024:Zambia / Q000453:epidemiology
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; D006454:Hemoglobins; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine