Effect of antiretroviral therapy on malaria incidence in HIV-infected Ugandan adults


Kasirye, RP; Grosskurth, H; Munderi, P; Levin, J; Anywaine, Z; Nunn, A; Kamali, A; Baisley, K; (2017) Effect of antiretroviral therapy on malaria incidence in HIV-infected Ugandan adults. AIDS (London, England), 31 (4). pp. 577-582. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0000000000001344

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Abstract

Introduction: Using the data of a trial on cotrimoxazole (CTX) cessation, we investigated the effect of different antiretroviral therapy (ART) regimens on the incidence of clinical malaria. Methods: During the cotrimoxazole cessation trial (ISRCTN44723643), HIV-infected Ugandan adultswith CD4+ at least 250 cells/mlwere randomized to receive either CTX prophylaxis or placebo and were followed for a median of 2.5 years. Blood slides for malaria microscopy were examined at scheduled visits and at unscheduled visits when the participant felt unwell. CD4+ cell counts were done 6-monthly. Malaria was defined as fever with a positive blood slide. ART regimens were categorized as nucleoside reverse transcriptase inhibitor (NRTI) only, non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing or protease inhibitor containing. Malaria incidence was calculated using random effects Poisson regression to account for clustering of events. Results: Malaria incidence in the three ART regimen groups was 9.9 (3.6-27.4), 9.3 (8.3-10.4), and 3.5 (1.6-7.6) per 100 person-years, respectively. Incidence on protease inhibitors was lower than that on the other regimens with the results just reaching significance (adjusted rate ratio 0.4, 95% confidence interval = 0.2-1.0, comparing with NNRTI regimens). Stratification by CTX/placebo use gave similar results, without evidence of an interaction between the effects of CTX/placebo use and ART regimen. There was no evidence of an interaction between ART regimen and CD4+ cell count. Conclusion: There was some evidence that protease inhibitor-containing ART regimens may be associated with a lower clinical malaria incidence compared with other regimens. This effect was not modified by CTX use or CD4+ cell count. The antimalarial properties of protease inhibitors may have clinical and public health importance. (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

Item Type: Article
Keywords: antiretroviral therapy, cotrimoxazole, HIV, malaria, cotrimoxazole prophylaxis, artemether-lumefantrine, plasmodium-falciparum, protease inhibitors, liver stages, children, exposure, agents, trial, risk, Immunology, Infectious Diseases, Virology
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
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PubMed ID: 28121670
Web of Science ID: 393754600018
URI: http://researchonline.lshtm.ac.uk/id/eprint/3983465

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