title: Malaria Parasitemia and Parasite Density in Antiretroviral-Treated HIV-Infected Adults Following Discontinuation of Cotrimoxazole Prophylaxis.
abstract: BACKGROUND
  Cotrimoxazole (CTX) discontinuation increases malaria incidence in human immunodeficiency virus (HIV)-infected individuals. Rates, quantity, and timing of parasitemia rebound following CTX remain undefined.
  
  
  METHODS
  Serial specimens from a trial of HIV-infected individuals receiving antiretroviral treatment (ART) randomized to continue (the CTX arm) or discontinue (the STOP-CTX arm) were examined for malaria parasites by quantitative reverse transcription polymerase chain reaction (PCR). Specimens obtained at enrollment and then quarterly for 12 months and at sick visits were assessed; multiplicity of infection was evaluated by PCR that targeted the polymorphic msp-1/msp-2 alleles.
  
  
  RESULTS
  Among 500 HIV-infected adults receiving ART (median ART duration, 4.5 years), 5% had detectable parasitemia at baseline. After randomization, parasite prevalence increased over time in the STOP-CTX arm, compared with the CTX arm, with values of 4% and <1%, respectively, at month 3, 8% and 2% at month 6, 14% and 2% at month 9, and 22% and 4% at month 12 (P = .0034). The combined mean parasite density at the various time points was higher in the STOP-CTX arm (4.42 vs 3.13 log10parasites/mL; P < .001). The parasitemia incidence was 42.0 cases per 100 person-years in the STOP-CTX arm and 9.9 cases per 100 person-years in the CTX arm, with an incidence rate ratio of 4.3 (95% confidence interval, 2.7-7.1; P < .001). After enrollment, mixed infections (multiplicity of infection, >1) were only present in the STOP-CTX arm.
  
  
  CONCLUSIONS
  Discontinuation of CTX by HIV-infected adults receiving ART resulted in progressive increases in malaria parasitemia prevalence and burden.
  
  
  BACKGROUND
  NCT01425073.
authors.affiliation: US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research/Kenya Medical Research Institute.|Department of Medical Immunology, Maseno University, Kisumu, Kenya.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Ottichilo
authors.affiliation: Kenya Medical Research Institute, Nairobi.|US Military HIV Research Program, Henry Jackson Foundation, Walter Reed Army Institute of Research, Bethesda, Maryland.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Polyak
authors.affiliation: Department of Medical Immunology, Maseno University, Kisumu, Kenya.
authors.forename: Bernard
authors.initials: B
authors.lastname: Guyah
authors.affiliation: Department of Medicine.
authors.forename: Benson
authors.initials: B
authors.lastname: Singa
authors.affiliation: US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research/Kenya Medical Research Institute.
authors.forename: Josphat
authors.initials: J
authors.lastname: Nyataya
authors.affiliation: Department of Global Health.
authors.forename: Krista
authors.initials: K
authors.lastname: Yuhas
authors.affiliation: US Military HIV Research Program, Henry Jackson Foundation, Walter Reed Army Institute of Research, Bethesda, Maryland.|Department of Global Health.|Department of Pediatrics.|Department of Epidemiology, University of Washington, Seattle.
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.affiliation: US Army Medical Research Directorate-Kenya, Walter Reed Army Institute of Research/Kenya Medical Research Institute.
authors.forename: John N
authors.initials: JN
authors.lastname: Waitumbi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008288:Malaria / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D055118:Medication Adherence; D059208:Parasite Load; D018512:Parasitemia / Q000453:epidemiology; D010963:Plasmodium falciparum / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: HIV; adults; antiretroviral treatment; cotrimoxazole; malaria; parasitemia