title: The effect of intermittent preventive treatment during pregnancy on malarial antibodies depends on HIV status and is not associated with poor delivery outcomes.
abstract: BACKGROUND
  Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for malaria prevention in sub-Saharan Africa. However, studies reporting the effect of IPTp on malaria-specific immunity are scarce and are based on findings in human immunodeficiency virus (HIV)-negative primigravidae.
  
  
  METHODS
  Plasma samples obtained from 302 pregnant women (177 who were HIV negative, 88 who were HIV positive, and 37 who were of unknown HIV status) participating in a placebo-controlled trial of IPTp with SP (IPTp-SP) were analyzed for the presence of antibodies against merozoite antigens, whole asexual parasites, and variant surface antigens from chondroitin sulfate A-binding and nonbinding lines. Antibody levels were compared between intervention groups, and their association with morbidity outcomes was assessed.
  
  
  RESULTS
  HIV-positive mothers receiving SP had lower levels of peripheral antibodies against apical membrane antigen-1 and variant surface antigens, as well as lower levels of cord antibodies against erythrocyte-binding antigen-175 and parasite lysate, than did HIV-positive placebo recipients. No difference between intervention groups was observed among HIV-negative mothers. High antibody levels were associated with maternal infection and an increased risk of a first malaria episode in infants. Antibody responses were not consistently associated with reduced maternal anemia, prematurity, or low birth weight.
  
  
  CONCLUSIONS
  The IPTp-associated reduction in antibodies in HIV-infected women, but not in HIV-uninfected women, may reflect a higher efficacy of the intervention in preventing malaria among HIV-positive mothers. This reduction did not translate into an enhanced risk of malaria-associated morbidity in mothers and infants. Trial registration. Clinicaltrials.gov identifier NCT00209781.
authors: Barcelona Centre for International Health Research, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
authors: Elisa
authors: E
authors: Serra-Casas
authors: Clara
authors: C
authors: Menéndez
authors: Azucena
authors: A
authors: Bardají
authors: Llorenç
authors: L
authors: Quintó
authors: Carlota
authors: C
authors: Dobaño
authors: Betuel
authors: B
authors: Sigauque
authors: Alfons
authors: A
authors: Jiménez
authors: Inacio
authors: I
authors: Mandomando
authors: Virander S
authors: VS
authors: Chauhan
authors: Chetan E
authors: CE
authors: Chitnis
authors: Pedro L
authors: PL
authors: Alonso
authors: Alfredo
authors: A
authors: Mayor
mesh_terms: D000913:Antibodies, Protozoan / Q000097:blood*; D000962:Antimalarials / Q000008:administration & dosage*; D018890:Chemoprevention; D004334:Drug Administration Schedule; D004338:Drug Combinations; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D015658:HIV Infections / Q000150:complications / Q000276:immunology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets; D016778:Malaria, Falciparum / Q000150:complications / Q000517:prevention & control*; D009073:Mozambique; D010919:Placebos; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011739:Pyrimethamine / Q000008:administration & dosage*; D013413:Sulfadoxine / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000913:Antibodies, Protozoan; D000962:Antimalarials; D004338:Drug Combinations; D010919:Placebos; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine