title: The effects of ACT treatment and TS prophylaxis on Plasmodium falciparum gametocytemia in a cohort of young Ugandan children.
abstract: Artemisinin-based combination therapies (ACTs) and trimethoprim-sulfamethoxazole (TS) prophylaxis are important tools for malaria control, but there are concerns about their effect on gametocytes, the stage of the parasite responsible for transmission. We conducted a longitudinal clinical trial in a cohort of HIV-infected and uninfected children living in an area of high malaria transmission intensity in Uganda. Study participants were randomized to artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP) for all treatments of uncomplicated malaria (N = 4,380) as well as TS prophylaxis for different durations. The risks of gametocytemia detected by microscopy in the 28 days after antimalarial therapy were compared using multivariate analyses. The risk of gametocyte detection was significantly higher in patients treated with DP compared with AL (adjusted relative risk = 1.85, P < 0.001) and among children prescribed TS prophylaxis (adjusted relative risk = 1.76, P < 0.001). The risk of gametocytemia and its potential for increasing transmission should be considered when evaluating different ACTs and TS prophylaxis for malaria control.
authors: Infectious Diseases Research Collaboration, Kampala, Uganda. abelkakuru@gmail.com
authors: Abel
authors: A
authors: Kakuru
authors: Prasanna
authors: P
authors: Jagannathan
authors: Emmanuel
authors: E
authors: Arinaitwe
authors: Humphrey
authors: H
authors: Wanzira
authors: Mary
authors: M
authors: Muhindo
authors: Victor
authors: V
authors: Bigira
authors: Emmanuel
authors: E
authors: Osilo
authors: Jaco
authors: J
authors: Homsy
authors: Moses R
authors: MR
authors: Kamya
authors: Jordan W
authors: JW
authors: Tappero
authors: Grant
authors: G
authors: Dorsey
mesh_terms: D000962:Antimalarials / Q000494:pharmacology / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002675:Child, Preschool; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D004983:Ethanolamines / Q000627:therapeutic use; D005449:Fluorenes / Q000627:therapeutic use; D015658:HIV Infections / Q000473:pathology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000188:drug therapy* / Q000469:parasitology; D015999:Multivariate Analysis; D018512:Parasitemia / Q000188:drug therapy / Q000469:parasitology; D010963:Plasmodium falciparum / Q000187:drug effects* / Q000472:pathogenicity; D056990:Post-Exposure Prophylaxis; D015995:Prevalence; D016016:Proportional Hazards Models; D011804:Quinolines / Q000627:therapeutic use*; D012307:Risk Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D053058:Trophozoites / Q000187:drug effects*; D014454:Uganda; D010879:Piperazines
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011804:Quinolines; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
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