Cotrimoxazole versus sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria in HIV-infected pregnant women in Bangui, Central African Republic: A pragmatic randomised controlled trial.

Autor: Manirakiza A; Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic., Tondeur L; Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France., Ketta MYB; Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic., Sepou A; Hôpital Communautaire of Bangui, Ministry of Health, Bangui, Central African Republic., Serdouma E; Hôpital de l'Amitié, Ministry of Health, Bangui, Central African Republic., Gondje S; Maternité de la Gendarmerie, Ministry of Health, Bangui, Central African Republic., Bata GGB; Maternité du Centre de Santé des Castors, Ministry of Health, Bangui, Central African Republic., Boulay A; Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France., Moyen JM; Malaria Programme Division, Ministry of Health, Bangui, Central African Republic., Sakanga O; Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic., Le-Fouler L; Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France., Kazanji M; Institut Pasteur of Guyane, Cayenne, French Guiana., Briand V; Inserm, Institut de Recherche pour le Développement, University of Bordeaux, Bordeaux, France., Lombart JP; Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic., Vray M; Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France.; National Institut of Medical Research, Paris, France.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2021 Oct; Vol. 26 (10), pp. 1314-1323. Date of Electronic Publication: 2021 Sep 07.
DOI: 10.1111/tmi.13668
Abstrakt: Objective: The main objective of the MACOMBA (Maternity and Control of Malaria-HIV co-infection in Bangui) trial was to show that cotrimoxazole (CTX) is more effective than sulphadoxine-pyremethamine-IPTp (IPTp-SP) to prevent placental malaria infection (primary end point) among HIV-positive pregnant women with a CD4+ count ≥350 cells/mm 3 in Bangui, CAR.
Methods: MACOMBA is a multicentre, open-label randomised trial conducted in four maternity hospitals in Bangui. Between 2013 and 2017, 193 women were randomised and 112 (59 and 53 in CTX and IPTp-SP arms, respectively) were assessed for placental infection defined by microscopic parasitaemia or PCR.
Results: Thirteen women had a placental infection: five in the CTX arm (one by microscopic placental parasitaemia and four by PCR) and eight by PCR in the SP-IPTp (8.5% vs. 15.1%, p = 0.28). The percentage of newborns with low birthweight (<2500 g) did not differ statistically between the two arms. Self-reported compliance to CTX prophylaxis was good. There was a low overall rate of adverse events in both arms.
Conclusion: Although our results do not allow us to conclude that CTX is more effective, drug safety and good compliance among women with this treatment favour its widespread use among HIV-infected pregnant women, as currently recommended by WHO.
(© 2021 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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