High burden of malaria among Malawian adults on antiretroviral therapy after discontinuing prophylaxis.

Autor:	Mungwira RG; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Laurens MB; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA., Nyangulu W; Dignitas International, Zomba, Malawi., Divala TH; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Nampota-Nkomba N; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Buchwald AG; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA., Nyirenda OM; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Mwinjiwa E; Dignitas International, Zomba, Malawi., Kanjala M; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Galileya LT; Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi., Earland DE; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA., Adams M; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA., Plowe CV; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA., Taylor TE; Michigan State University, East Lansing, Michigan, USA., Mallewa J; Department of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi., van Oosterhout JJ; Dignitas International, Zomba, Malawi., Laufer MK; Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA.
Jazyk:	angličtina
Zdroj:	AIDS (London, England) [AIDS] 2022 Oct 01; Vol. 36 (12), pp. 1675-1682. Date of Electronic Publication: 2022 Jul 15.
DOI:	10.1097/QAD.0000000000003317
Abstrakt:	Objective: Many individuals living with the human immunodeficiency virus (HIV) infection and receiving antiretroviral therapy (ART) reside in areas at high risk for malaria but how malaria affects clinical outcomes is not well described in this population. We evaluated the burden of malaria infection and clinical malaria, and impact on HIV viral load and CD4 + cell count among adults on ART. Design: We recruited Malawian adults on ART who had an undetectable viral load and ≥250 CD4 +  cells/μl to participate in this randomized trial to continue daily trimethoprim-sulfamethoxazole (TS), discontinue daily co-trimoxazole, or switch to weekly chloroquine (CQ). Methods: We defined clinical malaria as symptoms consistent with malaria and positive blood smear, and malaria infection as Plasmodium falciparum DNA detected from dried blood spots (collected every 4-12 weeks). CD4 + cell count and viral load were measured every 24 weeks. We used Poisson regression and survival analysis to compare the incidence of malaria infection and clinical malaria. Clinicaltrials.gov NCT01650558. Results: Among 1499 participants enrolled, clinical malaria incidence was 21.4/100 person-years of observation (PYO), 2.4/100 PYO and 1.9/100 PYO in the no prophylaxis, TS, and CQ arms, respectively. We identified twelve cases of malaria that led to hospitalization and all individuals recovered. The preventive effect of staying on prophylaxis was approximately 90% compared to no prophylaxis (TS: incidence rate ratio [IRR] 0.11, 95% confidence interval [CI] 0.08, 0.15 and CQ: IRR 0.09, 95% CI 0.06, 0.13). P. falciparum infection prevalence among all visits was 187/1475 (12.7%), 48/1563 (3.1%), and 29/1561 (1.9%) in the no prophylaxis, TS, and CQ arms, respectively. Malaria infection and clinical malaria were not associated with changes in CD4 + cell count or viral load. Conclusion: In clinically stable adults living with HIV on ART, clinical malaria was common after chemoprophylaxis stopped. However, neither malaria infection nor clinical illness appeared to affect HIV disease progression. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu