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Two-dose versus monthly intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine in HIV-seropositive pregnant Zambian women.
J Infect Dis. 2007 Dec 01; 196(11):1585-94.JI

Abstract

BACKGROUND

Intermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains controversial.

METHODS

We conducted a randomized, double-blind, placebo-controlled study of IPTp comparing the standard 2-dose sulfadoxine-pyrimethamine (SP) regimen with monthly IPTp among a cohort of HIV-positive pregnant Zambian women. Primary outcomes included placental malaria (by smear and histology) and maternal peripheral parasitemia at delivery.

RESULTS

There were no differences between monthly IPTp (n=224) and standard IPTp (n=232) in placental malaria by histopathology (26% vs. 29%; relative risk [RR], 0.90 [95% confidence interval {CI}, 0.64-1.26]) or placental parasitemia (2% vs. 4%; RR, 0.55 [95% CI, 0.17-1.79]). There also were no differences in maternal anemia, stillbirths, preterm delivery, LBW, or all-cause mortality of infants at 6 weeks.

CONCLUSIONS

In an area of mesoendemicity in Zambia, monthly SP IPTp was not more efficacious than the standard 2-dose regimen for the prevention of placental malaria or adverse birth outcomes. IPTp policy recommendations need to take into account local malaria transmission patterns and the prevalence of HIV.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00270530.

Authors+Show Affiliations

Center for International Health and Development, Boston University School of Public Health, Boston, MA 02118, USA. dhamer@bu.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18008241

Citation

Hamer, Davidson H., et al. "Two-dose Versus Monthly Intermittent Preventive Treatment of Malaria With Sulfadoxine-pyrimethamine in HIV-seropositive Pregnant Zambian Women." The Journal of Infectious Diseases, vol. 196, no. 11, 2007, pp. 1585-94.
Hamer DH, Mwanakasale V, Macleod WB, et al. Two-dose versus monthly intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine in HIV-seropositive pregnant Zambian women. J Infect Dis. 2007;196(11):1585-94.
Hamer, D. H., Mwanakasale, V., Macleod, W. B., Chalwe, V., Mukwamataba, D., Champo, D., Mwananyanda, L., Chilengi, R., Mubikayi, L., Mulele, C. K., Mulenga, M., Thea, D. M., & Gill, C. J. (2007). Two-dose versus monthly intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine in HIV-seropositive pregnant Zambian women. The Journal of Infectious Diseases, 196(11), 1585-94.
Hamer DH, et al. Two-dose Versus Monthly Intermittent Preventive Treatment of Malaria With Sulfadoxine-pyrimethamine in HIV-seropositive Pregnant Zambian Women. J Infect Dis. 2007 Dec 1;196(11):1585-94. PubMed PMID: 18008241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Two-dose versus monthly intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine in HIV-seropositive pregnant Zambian women. AU - Hamer,Davidson H, AU - Mwanakasale,Victor, AU - Macleod,William B, AU - Chalwe,Victor, AU - Mukwamataba,Doreen, AU - Champo,Davies, AU - Mwananyanda,Lawrence, AU - Chilengi,Roma, AU - Mubikayi,Lwambwa, AU - Mulele,Chikuli Kabika, AU - Mulenga,Modest, AU - Thea,Donald M, AU - Gill,Christopher J, Y1 - 2007/10/25/ PY - 2006/12/20/received PY - 2007/06/12/accepted PY - 2007/11/17/pubmed PY - 2007/12/29/medline PY - 2007/11/17/entrez SP - 1585 EP - 94 JF - The Journal of infectious diseases JO - J Infect Dis VL - 196 IS - 11 N2 - BACKGROUND: Intermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains controversial. METHODS: We conducted a randomized, double-blind, placebo-controlled study of IPTp comparing the standard 2-dose sulfadoxine-pyrimethamine (SP) regimen with monthly IPTp among a cohort of HIV-positive pregnant Zambian women. Primary outcomes included placental malaria (by smear and histology) and maternal peripheral parasitemia at delivery. RESULTS: There were no differences between monthly IPTp (n=224) and standard IPTp (n=232) in placental malaria by histopathology (26% vs. 29%; relative risk [RR], 0.90 [95% confidence interval {CI}, 0.64-1.26]) or placental parasitemia (2% vs. 4%; RR, 0.55 [95% CI, 0.17-1.79]). There also were no differences in maternal anemia, stillbirths, preterm delivery, LBW, or all-cause mortality of infants at 6 weeks. CONCLUSIONS: In an area of mesoendemicity in Zambia, monthly SP IPTp was not more efficacious than the standard 2-dose regimen for the prevention of placental malaria or adverse birth outcomes. IPTp policy recommendations need to take into account local malaria transmission patterns and the prevalence of HIV. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00270530. SN - 0022-1899 UR - https://www.unboundmedicine.com/medline/citation/18008241/Two_dose_versus_monthly_intermittent_preventive_treatment_of_malaria_with_sulfadoxine_pyrimethamine_in_HIV_seropositive_pregnant_Zambian_women_ L2 - https://academic.oup.com/jid/article-lookup/doi/10.1086/522142 DB - PRIME DP - Unbound Medicine ER -