Malaria treatment efficacy among people living with HIV: the role of host and parasite factors

Miriam K Laufer, Joep J G van Oosterhout, Phillip C Thesing, Fraction K Dzinjalamala, Teresa Hsi, Lorraine Beraho, Stephen M Graham, Terrie E Taylor, Christopher V Plowe

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Identification of an effect of HIV-associated immunosuppression on response to antimalarial therapy would help guide management of malaria infection in areas of high HIV prevalence. Therefore, we conducted an observational study of people living with HIV infection in Blantyre, Malawi. Participants who developed malaria were treated with sulfadoxine-pyrimethamine (SP) and followed for 28 days. Molecular markers for SP resistance were measured. One hundred seventy-eight episodes of malaria were assessed. The 28-day cumulative treatment failure rate was 29.1%. In univariate analysis, CD4 cell count was not associated with treatment failure (hazard ratio 0.6, 95% confidence interval 0.3-1.2). Among children, the risk of treatment failure increased with infection with SP-resistant parasites and anemia. Decreased CD4 cell count was not associated with impaired response to antimalarial therapy or diminished ability to clear SP-resistant parasites, suggesting that acquired immunity to malaria is retained in the face of HIV-associated immunosuppression.

Original languageEnglish
Pages (from-to)627-632
Number of pages6
JournalAmerican Journal of Tropical Medicine and Hygiene
Volume77
Issue number4
DOIs
StatePublished - Oct 2007

Keywords

  • Adolescent
  • Adult
  • Antimalarials/therapeutic use
  • CD4 Lymphocyte Count
  • Child
  • Child, Preschool
  • Cohort Studies
  • Drug Combinations
  • Drug Resistance, Multiple
  • Endemic Diseases
  • Female
  • HIV Infections/immunology
  • Humans
  • Immunocompromised Host
  • Longitudinal Studies
  • Malaria/drug therapy
  • Malawi/epidemiology
  • Male
  • Parasitemia/immunology
  • Pyrimethamine/therapeutic use
  • Sulfadoxine/therapeutic use
  • Treatment Outcome

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