Intermittent Preventive Treatment With Dihydroartemisinin-Piperaquine for the Prevention of Malaria Among HIV-Infected Pregnant Women.
Daily trimethoprim-sulfamethoxazole (TMP-SMX) and insecticide-treated nets remain the main interventions for prevention of malaria in human immunodeficiency virus (HIV)-infected pregnant women in Africa. However, antifolate and pyrethroid resistance threaten the effectiveness of these interventions, and new ones are needed.



We conducted a double-blinded, randomized, placebo-controlled trial comparing daily TMP-SMX plus monthly dihydroartemisinin-piperaquine (DP) to daily TMP-SMX alone in HIV-infected pregnant women in an area of Uganda where indoor residual spraying of insecticide had recently been implemented. Participants were enrolled between gestation weeks 12 and 28 and given an insecticide-treated net. The primary outcome was detection of active or past placental malarial infection by histopathologic analysis. Secondary outcomes included incidence of malaria, parasite prevalence, and adverse birth outcomes.



All 200 women enrolled were followed through delivery, and the primary outcome was assessed in 194. There was no statistically significant difference in the risk of histopathologically detected placental malarial infection between the daily TMP-SMX plus DP arm and the daily TMP-SMX alone arm (6.1% vs. 3.1%; relative risk, 1.96; 95% confidence interval, .50-7.61; P = .50). Similarly, there were no differences in secondary outcomes.



Among HIV-infected pregnant women in the setting of indoor residual spraying of insecticide, adding monthly DP to daily TMP-SMX did not reduce the risk of placental or maternal malaria or improve birth outcomes.



NCT02282293.
Infectious Diseases Research Collaboration.
Paul
P
Natureeba
Infectious Diseases Research Collaboration.
Abel
A
Kakuru
Infectious Diseases Research Collaboration.
Mary
M
Muhindo
Infectious Diseases Research Collaboration.
Teddy
T
Ochieng
Infectious Diseases Research Collaboration.
John
J
Ategeka
Department of Medicine.
Catherine A
CA
Koss
Department of Medicine.
Albert
A
Plenty
Center for AIDS Prevention Studies.
Edwin D
ED
Charlebois
Department of Medicine.
Tamara D
TD
Clark
Infectious Diseases Research Collaboration.
Bridget
B
Nzarubara
Department of Obstetrics and Gynecology.
Miriam
M
Nakalembe
Departments of 6Obstetrics and Gynecology.
Deborah
D
Cohan
Pathology.
Gabrielle
G
Rizzuto
Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia.
Atis
A
Muehlenbachs
Pediatrics, University of California, San Francisco.
Theodore
T
Ruel
Department of Medicine.
Prasanna
P
Jagannathan
Department of Medicine.
Diane V
DV
Havlir
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Moses R
MR
Kamya
Department of Medicine.
Grant
G
Dorsey
D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D037621:Artemisinins / Q000627:therapeutic use*; D004311:Double-Blind Method; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000469:parasitology*; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D011804:Quinolines / Q000627:therapeutic use*; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014454:Uganda; D055815:Young Adult; D010879:Piperazines
D000962:Antimalarials; D037621:Artemisinins; D011804:Quinolines; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
HIV; dihydroartemisinin-piperaquine; malaria; pregnancy; trimethoprim-sulfamethoxazole