Tolerability of mefloquine intermittent preventive treatment for malaria in HIV-infected pregnant women in Benin.
OBJECTIVE
To investigate the tolerability of mefloquine intermittent preventive treatment (MQ IPTp) for malaria in HIV-infected pregnant women compared with HIV-negative women.


METHODS
Prospective cohort study comparing samples of HIV-negative and HIV-infected pregnant women from 2 clinical trials conducted in Benin.


METHODS
One hundred and three HIV-infected women from the ongoing PACOME trial were compared with 421 HIV-negative women from a former trial, both trials aiming to evaluate the efficacy and tolerability of MQ IPTp, administered at the dose of 15 mg/kg. Descriptive analysis compared the proportion of women reporting at least 1 adverse reaction, according to HIV status. Multilevel logistic regression identified factors associated with the probability of reporting an adverse reaction for each MQ intake.


RESULTS
Dizziness and vomiting were the most frequent adverse reactions. Adverse reactions were less frequent in HIV-infected women (65% versus 78%, P = 0.009). In multilevel analysis, HIV infection [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.08 to 0.61] decreased the risk for adverse reactions, whereas detectable viral load (OR = 2.46, 95% CI = 1.07 to 5.66), first intake (versus further intakes, OR = 5.26, 95% CI = 3.70 to 7.14), older age (OR = 1.62, 95% CI = 1.13 to 2.32), and higher education level (OR = 1.71, 95% CI = 1.12 to 2.61) increased the risk. Moderate and severe adverse reactions were more frequent when antiretrovirals were started concomitantly with a MQ intake.


CONCLUSIONS
This study provides reassuring data on the use of MQ IPTp in HIV-infected pregnant women. However frequent, adverse reactions remained moderate and did not impair adherence to MQ IPTp. In this high-risk group, MQ might be an acceptable alternative in case sulfadoxine-pyrimethamine loses its efficacy for intermittent preventive treatment.
UMR 216, Institut de Recherche pour le Développement and Université Paris Descartes, Paris, France. lisedenoeud@yahoo.fr
Lise
L
Denoeud-Ndam
Marie-Caroline
MC
Clément
Valérie
V
Briand
Jocelyn
J
Akakpo
Videhouenou K
VK
Agossou
Félix
F
Atadokpédé
Lucien
L
Dossou-Gbété
Didier G
DG
Komongui
Aldric
A
Afangnihoun
Pierre-Marie
PM
Girard
Djimon-Marcel
DM
Zannou
Michel
M
Cot
D000328:Adult; D000962:Antimalarials / Q000008:administration & dosage / Q000009:adverse effects*; D001541:Benin; D018890:Chemoprevention / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008288:Malaria / Q000517:prevention & control*; D015767:Mefloquine / Q000008:administration & dosage / Q000009:adverse effects*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011446:Prospective Studies
D000962:Antimalarials; D015767:Mefloquine