Department of Pharmacology & Therapeutics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Pathog Glob Health. 2013 Mar;107(2):69-77. doi: 10.1179/2047773213Y.0000000077.
Febrile illnesses occur frequently among HIV positive patients and these are often treated presumptively as malaria in endemic areas. Parasite-based diagnosis of malaria will eliminate unnecessary treatment, reduce drug-drug interactions and the chances for the emergence of drug resistant Plasmodium. We evaluated finger prick blood samples from 387 people living with HIV (PLWHIV) and suspected of having malaria by expert microscopy and Paracheck-Pf(TM) - a histidine-rich protein-II based malaria rapid diagnostic test. The study was conducted at the PEPFAR supported AIDS Prevention Initiative in Nigeria (APIN) Clinic of the University College Hospital Ibadan, southwest Nigeria. Outcome parameters were prevalence of malaria parasitemia, sensitivity and specificity of Paracheck-Pf as well as the positive and negative predictive values for Paracheck-Pf using microscopy of Giemsa-stained blood film as gold standard. Malaria parasites were detected in 19·1% (74/387) of enrollees by microscopy and 19·3% (74/383) by Paracheck-Pf. Geometric mean parasite density was 501/μl (range 39-749 202/μl). Sensitivity and specificity of Paracheck-Pf at all parasite densities were 55·4% and 89·3% while corresponding figures at parasite densities ≥200/μl were 90·9% and 90·3%. Sensitivity and specificity at parasite densities ≥500/μl was 97·6% and 90·3%. Positive and negative predictive values for parasite density ≥200/μl were 55·4% and 98·7%, respectively. Paracheck-Pf was found to be a useful malaria diagnostic tool at parasite densities ≥200/μl facilitating appropriate clinical management.
在 HIV 阳性患者中，发热性疾病经常发生，在流行地区，这些疾病通常被推测为疟疾进行治疗。寄生虫为基础的疟疾诊断将消除不必要的治疗，减少药物相互作用的机会，并降低疟原虫耐药性的出现。我们评估了来自 387 名 HIV 阳性患者（PLWHIV）的指尖血样本，这些患者疑似患有疟疾，通过专家显微镜检查和 Paracheck-Pf（TM）-一种基于组氨酸丰富蛋白-II 的疟疾快速诊断测试进行检测。这项研究是在尼日利亚（APIN）大学学院医院艾滋病预防倡议 PEPFAR 支持的诊所进行的，位于尼日利亚西南部伊巴丹。研究的结局参数是疟疾寄生虫血症的流行率、Paracheck-Pf 的敏感性和特异性，以及使用吉姆萨染色血涂片显微镜检查作为金标准时 Paracheck-Pf 的阳性和阴性预测值。通过显微镜检查在 19.1%（74/387）的入组者中检测到疟原虫，在 19.3%（74/383）的入组者中通过 Paracheck-Pf 检测到。寄生虫的几何平均密度为 501/μl（范围 39-749 202/μl）。在所有寄生虫密度下，Paracheck-Pf 的敏感性和特异性分别为 55.4%和 89.3%，而在寄生虫密度≥200/μl 时，相应的数值分别为 90.9%和 90.3%。在寄生虫密度≥500/μl 时，敏感性和特异性分别为 97.6%和 90.3%。寄生虫密度≥200/μl 的阳性和阴性预测值分别为 55.4%和 98.7%。Paracheck-Pf 在寄生虫密度≥200/μl 时是一种有用的疟疾诊断工具，有助于进行适当的临床管理。
