Effects of trimethoprim-sulfamethoxazole and insecticide-treated bednets on malaria among HIV-infected Ugandan children.

Abstract

BACKGROUND:

Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis and insecticide-treated bednets reduce malaria risk among HIV-infected adults. The efficacy of TMP/SMX may be diminished where antifolate resistance to malaria is high. We evaluated the efficacy of these interventions for malaria prevention among Ugandan children.

METHODS:

We concurrently followed 300 HIV-infected children aged 1-10 years and a community-based cohort of 561 healthy children aged 1-11 years over 11 months in Kampala, Uganda. The HIV-infected children received TMP/SMX prophylaxis and insecticide treated bednets. In the community cohort, insecticide-treated bednets were introduced during the observation period. Children from both cohorts were followed using a standardized protocol to measure the incidence of malaria.

RESULTS:

Only nine episodes of malaria were diagnosed among HIV-infected children (incidence = 0.07/person-year) in comparison with 440 episodes among children from the community (incidence = 0.90/person-year; P < 0.0001). The use of insecticide-treated bednets was associated with a 43% reduction in malaria incidence (P < 0.001), and a combination of TMP/SMX and use of insecticide-treated bednets with a 97% reduction in malaria incidence (P < 0.001). The prevalence of five mutations associated with antifolate resistance was high among malaria cases detected in both the HIV (100%) and community cohorts (75%). Malaria accounted for only 4% of febrile episodes in the HIV cohort in comparison with 33% in the community-based cohort (P < 0.0001).

CONCLUSION:

In a malaria endemic area with a high level of molecular markers of antifolate resistance, the combined use of TMP/SMX prophylaxis and insecticide-treated bednets was associated with a dramatic reduction in malaria incidence among HIV-infected children.

• Authors: Moses R Kamya, Anne F Gasasira, Jane Achan, Tsedal Mebrahtu, Theodore Ruel, Adeodata Kekitiinwa, Edwin D Charlebois, Philip J Rosenthal, Diane Havlir, Grant Dorsey
• Journal: AIDS (London, England) (AIDS) Vol. 21 Issue 15 Pg. 2059-66 (Oct 01 2007) ISSN: 0269-9370 [Print] England
• PMID: 17885296 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Antimalarials
• Insecticides
• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• Antimalarials (therapeutic use)
• Bedding and Linens
• Case-Control Studies
• Child
• Child, Preschool
• Female
• HIV Infections (epidemiology)
• Humans
• Incidence
• Infant
• Insecticides (therapeutic use)
• Longitudinal Studies
• Malaria (epidemiology, prevention & control)
• Male
• Trimethoprim, Sulfamethoxazole Drug Combination (therapeutic use)
• Uganda (epidemiology)