title: Marked reduction in prevalence of malaria parasitemia and anemia in HIV-infected pregnant women taking cotrimoxazole with or without sulfadoxine-pyrimethamine intermittent preventive therapy during pregnancy in Malawi.
abstract: BACKGROUND
  Effectiveness of cotrimoxazole (CTX) compared with sulfadoxine-pyrimethamine (SP) intermittent-preventive-therapy (IPTp) for malaria in HIV-infected pregnant women is unknown. We examined effectiveness of CTX with or without SP-IPTp versus SP-IPTp at reducing malaria parasitemia and anemia.
  
  
  METHODS
  From 2005 to 2009, we conducted a cross-sectional study of HIV-infected pregnant women at Thyolo Hospital, Malawi. Blood was tested for malaria parasitemia and anemia (hemoglobin<11 g/dl). Data were collected on use of anti-malaria interventions and other risk factors. CTX prophylaxis policy for HIV-infected pregnant women was introduced in 2007, but implementation problems resulted in some women receiving both CTX and SP-IPTp.
  
  
  RESULTS
  We enrolled 1,142 women, of whom 1,121 had data on CTX and/or SP-IPTp intake. Of these, 49.7%, 29.8%, and 15.4% reported taking SP-IPTp only, CTX only and SP-IPTp plus CTX, respectively. Compared with women taking SP-IPTp, those taking SP-IPTp plus CTX and CTX were less likely to have malaria parasitemia (OR, [95%CI]: 0.09, [0.01-0.66] and 0.43, [0.19-0.97], respectively) or anemia (PR, [95% CI]: 0.67, [0.54-0.83] and 0.72, [0.61-0.83], respectively).
  
  
  CONCLUSIONS
  In HIV-infected pregnant women, daily CTX was associated with reduced malaria parasitemia and anemia compared with SP-IPTp. CTX plus SP-IPTp was associated with further reduction in malaria parasitemia but toxicity was not fully assessed.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Atupele
authors.initials: A
authors.lastname: Kapito-Tembo
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.forename: Michaël Boele
authors.initials: MB
authors.lastname: van Hensbroek
authors.forename: Kamija
authors.initials: K
authors.lastname: Phiri
authors.forename: Margaret
authors.initials: M
authors.lastname: Fitzgerald
authors.forename: Victor
authors.initials: V
authors.lastname: Mwapasa
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology* / Q000517:prevention & control; D000962:Antimalarials / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008288:Malaria / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D018512:Parasitemia / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use*; D013413:Sulfadoxine / Q000627:therapeutic use*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013413:Sulfadoxine; D011739:Pyrimethamine