title: Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women.
abstract: BACKGROUND
  Intermittent preventive treatment is recommended for pregnant women living in malaria endemic countries due to benefits for both mother and baby. However, the impact may not be the same in HIV-positive pregnant women, as HIV infection impairs a woman's immunity.
  
  
  OBJECTIVE
  To compare intermittent preventive treatment regimens for malaria in HIV-positive pregnant women living in malaria-endemic areas.
  
  
  METHODS
  In June 2011, we searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE; EMBASE; LILACS, the metaRegister of Controlled Trials (mRCT), reference lists and conference abstracts. We also contacted researchers and organizations for information on relevant trials.
  
  
  METHODS
  Randomized controlled trials comparing different intermittent preventive treatment regimens for preventing malaria in HIV-positive pregnant women in malaria-endemic areas.
  
  
  METHODS
  Two authors extracted data and assessed risk bias. Dichotomous variables were combined using risk ratios (RR) and mean differences (MD) for continuous outcomes, both with 95% confidence intervals (CI).
  
  
  RESULTS
  Two randomized trials with 722 HIV-positive pregnant women were included, comparing monthly regimens of sulfadoxine-pyrimethamine (SP) to the standard 2-dose regimen in the second and third trimesters. There were no statistically significant differences between monthly SP and 2-dose SP in rates of maternal anaemia, low birth weight, and neonatal mortality. In primigravidae and secondigravidiae, the monthly regimen was associated with less placental parasitaemia (RR 0.38, 95% CI 0.21 to 0.70, two trials) and less peripheral parasitaemia (RR 0.25, 95% CI 0.14 to 0.43, two trials), but no effect was demonstrated in multigravid women. Babies born to primigravidae and secundigravida women on monthly SP had a higher mean birth weight (weighted mean difference (WMD) 130 g; 95% CI 120 g to 150 g, two trials) than babies born to mothers on 2-dose SP. Multigravidae women treated with monthly SP had significant higher haemoglobin level than those treated with treated 2 dose SP (WMD 0.21 g/dL, 95% CI 0.15 g/dL to 0.27 g/dL, one trial). There were no trials that assessed other treatment regimens for intermittent preventive treatment in HIV-positive pregnant women.
  
  
  CONCLUSIONS
  Three or more doses of SP is superior to the standard two doses in HIV-positive pregnant women. However, since SP cannot be administered concurrently with co-trimoxazole - a drug often recommended for infection prophylaxis in HIV-positive pregnant women, new drugs and research is needed to address needs of HIV-positive pregnant women.
authors: Malaria Alert Center, College of Medicine, University of Malawi, P/Bag 360, Chichiri, Blantyre, Malawi.
authors: Don P
authors: DP
authors: Mathanga
authors: Olalekan A
authors: OA
authors: Uthman
authors: Jobiba
authors: J
authors: Chinkhumba
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D004338:Drug Combinations; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015597:Pregnancy Complications, Parasitic / Q000517:prevention & control*; D011739:Pyrimethamine / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D013413:Sulfadoxine / Q000627:therapeutic use*
chemical_list: D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine