UMR 216, Institut de Recherche pour le Développement and Université Paris Descartes, Paris, France.
J Acquir Immune Defic Syndr. 2012 Sep 1;61(1):64-72. doi: 10.1097/QAI.0b013e3182615a58.
To investigate the tolerability of mefloquine intermittent preventive treatment (MQ IPTp) for malaria in HIV-infected pregnant women compared with HIV-negative women.
Prospective cohort study comparing samples of HIV-negative and HIV-infected pregnant women from 2 clinical trials conducted in Benin.
One hundred and three HIV-infected women from the ongoing PACOME trial were compared with 421 HIV-negative women from a former trial, both trials aiming to evaluate the efficacy and tolerability of MQ IPTp, administered at the dose of 15 mg/kg. Descriptive analysis compared the proportion of women reporting at least 1 adverse reaction, according to HIV status. Multilevel logistic regression identified factors associated with the probability of reporting an adverse reaction for each MQ intake.
Dizziness and vomiting were the most frequent adverse reactions. Adverse reactions were less frequent in HIV-infected women (65% versus 78%, P = 0.009). In multilevel analysis, HIV infection [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.08 to 0.61] decreased the risk for adverse reactions, whereas detectable viral load (OR = 2.46, 95% CI = 1.07 to 5.66), first intake (versus further intakes, OR = 5.26, 95% CI = 3.70 to 7.14), older age (OR = 1.62, 95% CI = 1.13 to 2.32), and higher education level (OR = 1.71, 95% CI = 1.12 to 2.61) increased the risk. Moderate and severe adverse reactions were more frequent when antiretrovirals were started concomitantly with a MQ intake.
This study provides reassuring data on the use of MQ IPTp in HIV-infected pregnant women. However frequent, adverse reactions remained moderate and did not impair adherence to MQ IPTp. In this high-risk group, MQ might be an acceptable alternative in case sulfadoxine-pyrimethamine loses its efficacy for intermittent preventive treatment.
研究在感染艾滋病毒的孕妇中使用甲氟喹间歇预防治疗（MQ IPTp）治疗疟疾的耐受性，与未感染艾滋病毒的孕妇相比。
在贝宁进行的两项临床试验中，对 HIV 阴性和 HIV 阳性孕妇的样本进行前瞻性队列研究。
对正在进行的 PACOME 试验中的 103 名 HIV 阳性孕妇与前一次试验中的 421 名 HIV 阴性孕妇进行比较，这两项试验旨在评估 MQ IPTp 的疗效和耐受性，剂量为 15mg/kg。根据 HIV 状况，描述性分析比较了至少报告 1 种不良反应的妇女比例。多水平逻辑回归确定了与每次 MQ 摄入报告不良反应的概率相关的因素。
头晕和呕吐是最常见的不良反应。感染 HIV 的女性不良反应较少（65%对 78%，P=0.009）。在多水平分析中，HIV 感染（比值比[OR]为 0.23，95%置信区间[CI]为 0.08 至 0.61）降低了不良反应的风险，而可检测的病毒载量（OR 为 2.46，95%CI 为 1.07 至 5.66）、首次摄入（与进一步摄入相比，OR 为 5.26，95%CI 为 3.70 至 7.14）、年龄较大（OR 为 1.62，95%CI 为 1.13 至 2.32）和较高的教育水平（OR 为 1.71，95%CI 为 1.12 至 2.61）增加了风险。当抗逆转录病毒药物与 MQ 摄入同时开始时，中度和重度不良反应更为常见。
本研究为 HIV 感染孕妇使用 MQ IPTp 提供了令人安心的数据。然而，不良反应仍然频繁，但并不影响 MQ IPTp 的依从性。在这个高危人群中，如果磺胺多辛-乙胺嘧啶失去间歇性预防治疗的疗效，MQ 可能是一种可接受的替代药物。
