Abstract | BACKGROUND: METHODS: Febrile adults with Plasmodium falciparum parasitemia were treated with sulfadoxine-pyrimethamine and were monitored for 28 days. HIV status and CD4 cell count were determined at study enrollment. RESULTS: Of the adults enrolled in the study, 508 attended all follow-up visits, including 130 HIV-uninfected adults, 256 HIV-infected adults with a high CD4 cell count (> or =200 cells/ micro L), and 122 HIV-infected adults with a low CD4 cell count (<200 cells/ micro L). The hazard of treatment failure at day 28 of follow-up was significantly higher for HIV-infected adults with a low CD4 cell count (20.5%) than for HIV-uninfected adults (7.7%). Anemia ( hemoglobin level, <110 g/L) modified the effect of HIV status on treatment failure. When we controlled for fever and parasite density, the hazard of treatment failure for HIV-infected adults with a low CD4 cell count and anemia was 3.4 times higher than that for HIV-uninfected adults (adjusted hazard ratio, 3.38; 95% confidence interval, 1.56-7.34). CONCLUSIONS: HIV-infected persons with a low CD4 cell count and anemia have an increased risk of antimalarial treatment failure. The response to malaria treatment in HIV-infected persons must be carefully monitored. Proven measures for the control and prevention of malaria must be incorporated into the basic package of services provided by HIV/ acquired immunodeficiency syndrome care and treatment programs in malarious areas.
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Authors | Snehal N Shah, Ernest E Smith, Charles O Obonyo, Kevin C Kain, Peter B Bloland, Laurence Slutsker, Mary J Hamel |
Journal | The Journal of infectious diseases
(J Infect Dis)
Vol. 194
Issue 11
Pg. 1519-28
(Dec 01 2006)
ISSN: 0022-1899 [Print] United States |
PMID | 17083036
(Publication Type: Journal Article)
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Chemical References |
- Antimalarials
- Drug Combinations
- fanasil, pyrimethamine drug combination
- Sulfadoxine
- Pyrimethamine
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Topics |
- Adult
- Anemia
- Antimalarials
(pharmacology, therapeutic use)
- CD4 Lymphocyte Count
- Drug Combinations
- Female
- Fever
- HIV Infections
(complications, immunology)
- Humans
- Immunocompromised Host
- Kenya
- Malaria, Falciparum
(complications, drug therapy, immunology)
- Male
- Parasitemia
- Pyrimethamine
(pharmacology, therapeutic use)
- Recurrence
- Statistics as Topic
- Sulfadoxine
(pharmacology, therapeutic use)
- Treatment Failure
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