Mermin Jonathan, Ekwaru John Paul, Liechty Cheryl A, Were Willy, Downing Robert, Ransom Ray, Weidle Paul, Lule John, Coutinho Alex, Solberg Peter
CDC-Uganda, Global AIDS Program, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention (CDC), Entebbe, Uganda.
Lancet. 2006 Apr 15;367(9518):1256-61. doi: 10.1016/S0140-6736(06)68541-3.
HIV-1 and malaria are common infections in Africa, and cause substantial morbidity and mortality. HIV infection has been associated with an increased incidence of malaria, and more severe disease. Our aim was to assess the effect of antiretroviral treatment (ART) on the frequency of clinical malaria in people with HIV, and to measure the additive effects of co-trimoxazole (trimethoprim and sulfamethoxazole) prophylaxis, ART, and insecticide-treated bednets.
In 2001, we enrolled 466 HIV-infected individuals aged 18 years or older in Uganda in a prospective cohort study that provided co-trimoxazole prophylaxis to 399 participants after 5 months of no intervention. In 2003, we enrolled 138 survivors from the initial study, and 897 new participants from the same community, to take antiretroviral therapy (ART) in addition to co-trimoxazole prophylaxis. The ART was in most cases a combination of stavudine, lamivudine, and nevirapine or efavirenz. In 2004, we also gave participants insecticide-treated bednets. Households were visited weekly by study staff to record fever, illness, or death in the preceding 7 days. In cases of reported fever in the previous 2 days, we took blood to test for malaria parasites. We compared the frequency of clinical malaria, adjusting for CD4-cell count, age, sex, and season.
1035 individuals were given co-trimoxazole and ART (median age 38 years, 74% female, and median CD4-cell count 124 cells/microL); 985 of these, plus four new participants, received co-trimoxazole, ART, and bednets. There were 166 cases of clinical malaria in the study. Compared with a baseline malaria incidence of 50.8 episodes per 100 person-years, co-trimoxazole prophylaxis was associated with 9.0 episodes per 100 person-years (adjusted incidence rate ratio [IRR] 0.24, 95% CI 0.15-0.38); ART and co-trimoxazole with 3.5 episodes per 100 person-years (0.08, 0.04-0.17); and co-trimoxazole, ART, and bednets with 2.1 episodes per 100 person-years (0.05, 0.03-0.08). Malaria incidence was significantly lower during ART and co-trimoxazole than during co-trimoxazole alone (IRR 0.36 [95% CI 0.18-0.74], p=0.0056).
A combination of co-trimoxazole, antiretroviral therapy, and insecticide-treated bednets substantially reduced the frequency of malaria in adults with HIV.
HIV-1和疟疾是非洲常见的感染性疾病，会导致大量发病和死亡。HIV感染与疟疾发病率增加及病情更严重有关。我们的目的是评估抗逆转录病毒治疗（ART）对HIV感染者临床疟疾发生频率的影响，并衡量复方新诺明（甲氧苄啶和磺胺甲恶唑）预防、ART及经杀虫剂处理的蚊帐的叠加效果。
2001年，我们在乌干达招募了466名18岁及以上的HIV感染者参与一项前瞻性队列研究，在无干预5个月后，为399名参与者提供复方新诺明预防。2003年，我们招募了最初研究中的138名幸存者以及来自同一社区的897名新参与者，除复方新诺明预防外，还接受抗逆转录病毒治疗（ART）。在大多数情况下，ART是司他夫定、拉米夫定与奈韦拉平或依非韦伦的组合。2004年，我们还为参与者提供了经杀虫剂处理的蚊帐。研究人员每周走访各家庭，记录前7天内的发热、疾病或死亡情况。对于报告在前2天内发热的病例，我们采集血液检测疟原虫。我们比较了临床疟疾的发生频率，并对CD4细胞计数、年龄、性别和季节进行了校正。
1035人接受了复方新诺明和ART（中位年龄38岁，74%为女性，中位CD4细胞计数为124个/微升）；其中985人，加上4名新参与者，接受了复方新诺明、ART和蚊帐。该研究中有166例临床疟疾病例。与基线疟疾发病率每100人年50.8次发作相比，复方新诺明预防与每100人年9.0次发作相关（校正发病率比[IRR]0.24，95%CI 0.15 - 0.38）；ART与复方新诺明为每100人年3.5次发作（0.08，0.04 - 0.17）；复方新诺明、ART和蚊帐为每100人年2.1次发作（0.05，0.03 - 0.08）。ART和复方新诺明联合使用期间的疟疾发病率显著低于仅使用复方新诺明期间（IRR 0.36[95%CI 0.18 - 0.74]，p = 0.0056）。
复方新诺明、抗逆转录病毒治疗和经杀虫剂处理的蚊帐联合使用可大幅降低HIV感染成人的疟疾发生频率。
