Kamya Moses R, Gasasira Anne F, Achan Jane, Mebrahtu Tsedal, Ruel Theodore, Kekitiinwa Adeodata, Charlebois Edwin D, Rosenthal Philip J, Havlir Diane, Dorsey Grant
Makerere University Medical School, Kampala, Uganda.
AIDS. 2007 Oct 1;21(15):2059-66. doi: 10.1097/QAD.0b013e3282ef6da1.
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.
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.
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).
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.
复方新诺明预防用药和经杀虫剂处理的蚊帐可降低HIV感染成人患疟疾的风险。在对疟疾的抗叶酸耐药性较高的地区，复方新诺明的疗效可能会降低。我们评估了这些干预措施对乌干达儿童预防疟疾的效果。
在乌干达坎帕拉，我们对300名1至10岁的HIV感染儿童和一个由561名1至11岁健康儿童组成的社区队列进行了为期11个月的同期随访。HIV感染儿童接受复方新诺明预防用药和经杀虫剂处理的蚊帐。在社区队列中，在观察期内引入了经杀虫剂处理的蚊帐。对两个队列的儿童都采用标准化方案进行随访，以测量疟疾发病率。
HIV感染儿童中仅诊断出9例疟疾病例（发病率=0.07/人年），而社区儿童中有440例疟疾病例（发病率=0.90/人年；P<0.0001）。使用经杀虫剂处理的蚊帐可使疟疾发病率降低43%（P<0.001），复方新诺明与经杀虫剂处理的蚊帐联合使用可使疟疾发病率降低97%（P<0.001）。在HIV队列（100%）和社区队列（75%）中检测到的疟疾病例中，与抗叶酸耐药相关的五种突变的流行率很高。疟疾在HIV队列中仅占发热病例的4%，而在社区队列中占33%（P<0.0001）。
在抗叶酸耐药分子标志物水平较高的疟疾流行地区，复方新诺明预防用药与经杀虫剂处理的蚊帐联合使用可使HIV感染儿童的疟疾发病率显著降低。
