Barcelona Centre for International Health Research, Hospital Clínic/Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.
J Infect Dis. 2010 Jan 1;201(1):123-31. doi: 10.1086/648595.
Intermittent preventive treatment during pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended for malaria prevention in sub-Saharan Africa. However, studies reporting the effect of IPTp on malaria-specific immunity are scarce and are based on findings in human immunodeficiency virus (HIV)-negative primigravidae.
Plasma samples obtained from 302 pregnant women (177 who were HIV negative, 88 who were HIV positive, and 37 who were of unknown HIV status) participating in a placebo-controlled trial of IPTp with SP (IPTp-SP) were analyzed for the presence of antibodies against merozoite antigens, whole asexual parasites, and variant surface antigens from chondroitin sulfate A-binding and nonbinding lines. Antibody levels were compared between intervention groups, and their association with morbidity outcomes was assessed.
HIV-positive mothers receiving SP had lower levels of peripheral antibodies against apical membrane antigen-1 and variant surface antigens, as well as lower levels of cord antibodies against erythrocyte-binding antigen-175 and parasite lysate, than did HIV-positive placebo recipients. No difference between intervention groups was observed among HIV-negative mothers. High antibody levels were associated with maternal infection and an increased risk of a first malaria episode in infants. Antibody responses were not consistently associated with reduced maternal anemia, prematurity, or low birth weight.
The IPTp-associated reduction in antibodies in HIV-infected women, but not in HIV-uninfected women, may reflect a higher efficacy of the intervention in preventing malaria among HIV-positive mothers. This reduction did not translate into an enhanced risk of malaria-associated morbidity in mothers and infants. Trial registration. Clinicaltrials.gov identifier NCT00209781.
在撒哈拉以南非洲地区，推荐采用磺胺多辛-乙胺嘧啶（SP）间歇性预防治疗（IPTp）来预防疟疾。然而，目前有关 IPTp 对疟疾特异性免疫影响的研究较少，且这些研究都是基于人类免疫缺陷病毒（HIV）阴性初产妇的发现。
对参加 SP 间歇性预防治疗（IPTp-SP）安慰剂对照试验的 302 名孕妇（177 名 HIV 阴性，88 名 HIV 阳性，37 名 HIV 状况未知）的血浆样本进行了分析，以检测针对裂殖体抗原、全期无性寄生虫和软骨素 A 结合和非结合线变体表面抗原的抗体。比较了干预组之间的抗体水平，并评估了它们与发病率结局的关系。
接受 SP 的 HIV 阳性母亲外周血针对顶膜抗原 1 和变体表面抗原的抗体水平以及脐带血针对红细胞结合抗原 175 和寄生虫裂解物的抗体水平均低于接受安慰剂的 HIV 阳性母亲。HIV 阴性母亲的干预组之间没有差异。高抗体水平与母亲感染以及婴儿首次疟疾发作的风险增加有关。抗体反应与母亲贫血、早产或低出生体重的减少没有一致的相关性。
在 HIV 感染的女性中，IPTp 相关的抗体减少，但在 HIV 未感染的女性中没有，这可能反映了干预措施在预防 HIV 阳性母亲疟疾方面的更高疗效。这种减少并未导致母亲和婴儿疟疾相关发病率的风险增加。试验注册。Clinicaltrials.gov 标识符 NCT00209781。
