Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi.
Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Mrayland, USA.
AIDS. 2022 Oct 1;36(12):1675-1682. doi: 10.1097/QAD.0000000000003317. Epub 2022 Jul 15.
Many individuals living with the human immunodeficiency virus (HIV) infection and receiving antiretroviral therapy (ART) reside in areas at high risk for malaria but how malaria affects clinical outcomes is not well described in this population. We evaluated the burden of malaria infection and clinical malaria, and impact on HIV viral load and CD4 + cell count among adults on ART.
We recruited Malawian adults on ART who had an undetectable viral load and ≥250 CD4 + cells/μl to participate in this randomized trial to continue daily trimethoprim-sulfamethoxazole (TS), discontinue daily co-trimoxazole, or switch to weekly chloroquine (CQ).
We defined clinical malaria as symptoms consistent with malaria and positive blood smear, and malaria infection as Plasmodium falciparum DNA detected from dried blood spots (collected every 4-12 weeks). CD4 + cell count and viral load were measured every 24 weeks. We used Poisson regression and survival analysis to compare the incidence of malaria infection and clinical malaria. Clinicaltrials.gov NCT01650558.
Among 1499 participants enrolled, clinical malaria incidence was 21.4/100 person-years of observation (PYO), 2.4/100 PYO and 1.9/100 PYO in the no prophylaxis, TS, and CQ arms, respectively. We identified twelve cases of malaria that led to hospitalization and all individuals recovered. The preventive effect of staying on prophylaxis was approximately 90% compared to no prophylaxis (TS: incidence rate ratio [IRR] 0.11, 95% confidence interval [CI] 0.08, 0.15 and CQ: IRR 0.09, 95% CI 0.06, 0.13). P. falciparum infection prevalence among all visits was 187/1475 (12.7%), 48/1563 (3.1%), and 29/1561 (1.9%) in the no prophylaxis, TS, and CQ arms, respectively. Malaria infection and clinical malaria were not associated with changes in CD4 + cell count or viral load.
In clinically stable adults living with HIV on ART, clinical malaria was common after chemoprophylaxis stopped. However, neither malaria infection nor clinical illness appeared to affect HIV disease progression.
许多感染人类免疫缺陷病毒 (HIV) 并接受抗逆转录病毒治疗 (ART) 的个体居住在疟疾高发地区，但疟疾如何影响临床结局在该人群中描述得并不清楚。我们评估了疟疾感染和临床疟疾的负担，以及其对接受 ART 的成年人 HIV 病毒载量和 CD4+细胞计数的影响。
我们招募了马拉维接受 ART 的成年人，这些成年人的病毒载量无法检测到且 CD4+细胞≥250 个/μl，参加这项随机试验，以继续每日服用甲氧苄啶-磺胺甲恶唑 (TS)、停止每日复方磺胺甲噁唑、或改为每周服用氯喹 (CQ)。
我们将临床疟疾定义为符合疟疾症状且血涂片阳性的情况，将疟疾感染定义为从干血斑中检测到间日疟原虫 DNA（每 4-12 周采集一次）。每 24 周测量一次 CD4+细胞计数和病毒载量。我们使用泊松回归和生存分析来比较疟疾感染和临床疟疾的发生率。Clinicaltrials.gov NCT01650558。
在纳入的 1499 名参与者中，临床疟疾的发病率为 21.4/100 人年观察期 (PYO)，无预防组、TS 组和 CQ 组分别为 2.4/100 PYO 和 1.9/100 PYO。我们发现了 12 例导致住院的疟疾病例，所有患者均已康复。与无预防措施相比，继续预防的效果约为 90%（TS：发病率比[IRR] 0.11，95%置信区间 [CI] 0.08，0.15 和 CQ：IRR 0.09，95% CI 0.06，0.13）。在所有就诊中，无预防组、TS 组和 CQ 组的间日疟原虫感染率分别为 187/1475（12.7%）、48/1563（3.1%）和 29/1561（1.9%）。疟疾感染和临床疟疾均与 CD4+细胞计数或病毒载量的变化无关。
在接受 ART 的 HIV 稳定期成年人中，停止化学预防后，临床疟疾很常见。然而，疟疾感染或临床疾病似乎都不会影响 HIV 疾病的进展。
