Inferiority of Single-Dose Sulfadoxine-Pyrimethamine Intermittent Preventive Therapy for Malaria during Pregnancy among HIV-Positive Zambian Women

Gill, C. J.; MacLeod, W. B.; Mwanakasale, V.; Chalwe, V.; Mwananyanda, L.; Champo, D.; Mukwamataba, D.; Chilengi, R.; Thea, D. M.; Hamer, D. H.
December 2007
Journal of Infectious Diseases;12/1/2007, Vol. 196 Issue 11, p1577
Academic Journal
Background. The World Health Organization advocates 2-3 doses of sulfadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria (SP IPTp). The optimal number of doses and the consequences of singledose therapy remain unclear. Methods. Data were from a randomized, controlled study of human immunodeficiency virus-positive Zambian women comparing monthly versus 2-dose SP IPTp. We compared maternal and neonatal birth outcomes as a function of how many doses the mothers received (1 to ≥4 doses). Results. Of 387 deliveries, 34 received 1 dose of SP. Single-dose SP was significantly associated with higher proportions of maternal anemia, peripheral and cord blood parasitemia, infant prematurity, and low birth weight. SP conferred dose-dependent benefits, particularly in the transition from 1 to 2 doses of SP. Women randomized to the standard 2-dose regimen were much more likely to receive only 1 dose than were women randomized to monthly IPT (relative risk, 16.4 [95% confidence interval, 4.0-68.3]). Conclusions. Single-dose SP was a common result of trying to implement the standard 2-dose regimen and was inferior to all other dosing regimens. At a programmatic level, this implies that monthly SP IPTp may ultimately be more effective than the standard regimen by reducing the risk of inadvertently underdosing mothers.


Related Articles

  • Two-Dose versus Monthly Intermittent Preventive Treatment of Malaria with Sulfadoxine-Pyrimethamine in HIV-Seropositive Pregnant Zambian Women. Hamer, Davidson H.; Mwanakasale, Victor; MacLeod, William B.; Chalwe, Victor; Mukwamataba, Doreen; Champo, Davies; Mwananyanda, Lawrence; Chilengi, Roma; Mubikayi, Lwambwa; Mulele, Chikuli Kabika; Mulenga, Modest; Thea, Donald M.; Gill, Christopher J. // Journal of Infectious Diseases;12/1/2007, Vol. 196 Issue 11, p1585 

    Background. Intermittent preventive treatment of malaria during pregnancy (IPTp) reduces placental infection, maternal anemia, and low birth weight (LBW). However, the optimal dosing regimen in settings in which human immunodeficiency virus (HIV) is highly prevalent among pregnant women remains...

  • HIV-1 Disease Progression in Breast-Feeding and Formula-Feeding Mothers: A Prospective 2-Year Comparison of T Cell Subsets, HIV-1 RNA Levels, and Mortality. Otieno, Phelgona A.; Brown, Elizabeth R.; Mbori-Ngacha, Dorothy A.; Nduati, Ruth W.; Farquhar, Carey; Obimbo, Elizabeth M.; Bosire, Rose K.; Emery, Sandy; Overbaugh, Julie; Richardson, Barbra A.; John-Stewart, Grace C. // Journal of Infectious Diseases;1/15/2007, Vol. 195 Issue 2, p220 

    Background. There is conflicting evidence regarding the effects of breast-feeding on maternal mortality from human immunodeficiency virus type 1 (HIV-1) infection, and little is known about the effects of breast-feeding on markers of HIV-1 disease progression. Methods. HIV-1-seropositive women...

  • Pharmacokinetics of Sulfadoxine-Pyrimethamine in HIV-Infected and Uninfected Pregnant Women in Western Kenya. Green, Michael D.; van Eijk, Annemieke M.; van ter Kuile, Feiko O.; Ayisi, John G.; Parise, Monica E.; Kager, Piet A.; Nahlen, Bernard L.; Steketee, Richard; Nettey, Henry // Journal of Infectious Diseases;11/1/2007, Vol. 196 Issue 9, p1403 

    Background. Sulfadoxine-pyrimethamine (SP) is among the most commonly used antimalarial drugs during pregnancy, yet the pharmacokinetics of SP are unknown in pregnant women. HIV-infected (HIV+) women require more frequent doses of intermittent preventive therapy with SP than do HIV-uninfected...

  • Comparison of CD4 Cell Count, Viral Load, and Other Markers for the Prediction of Mortality among HIV-1-Infected Kenyan Pregnant Women. Brown, Elizabeth R.; Otieno, Phelgona; Mbori-Ngacha, Dorothy A.; Farquhar, Carey; Obimbo, Elizabeth M.; Nduati, Ruth; Overbaugh, Julie; John-Stewart, Grace C. // Journal of Infectious Diseases;5/1/2009, Vol. 199 Issue 9, p1292 

    Background. There are limited data regarding the relative merits of biomarkers as predictors of mortality or time to initiation of antiretroviral therapy (ART). Methods. We evaluated the usefulness of the CD4 cell count, CD4 cell percentage (CD4%), human immunodeficiency virus type 1 (HIV-1)...

  • Intermittent screening and treatment versus intermittent preventive treatment of malaria in pregnancy: user acceptability. Smith, Lucy A.; Jones, Caroline; Adjei, Rose O.; Antwi, Gifty D.; Afrah, Nana A.; Greenwood, Brian; Chandramohan, Daniel; Tagbor, Harry; Webster, Jayne // Malaria Journal;2010, Vol. 9, p1 

    Background: Malaria in pregnancy is associated with increased risks of maternal and foetal complications. Currently, intermittent preventive treatment (IPT) of malaria during pregnancy with sulphadoxine-pyrimethamine (SP) is recommended by the WHO as part of a package of interventions also...

  • Intermittent preventive treatment of malaria during pregnancy in central Mozambique. Brentlinger, Paula E.; Dgedge, Martinho; Correia, Maria Ana Chadreque; Rojas, Ana Judith Blanco; Saúte, Francisco; Gimbel-Sherr, Kenneth H.; Stubbs, Benjamin A.; Mercer, Mary Anne; Gloyd, Stephen // Bulletin of the World Health Organization;Nov2007, Vol. 85 Issue 11, p873 

    Problem New WHO strategies for control of malaria in pregnancy (MiP) recommend intermittent preventive treatment (IPTp), bednet use and improved case management. Approach A pilot MiP programme in Mozambique was designed to determine requirements for scale-up. Local setting The Ministry of Health...

  • HIV IN PREGNANT WOMEN IN WEST AFRICA. Hughes, Glenys // Journal of Epidemiology & Community Health;Dec2007, Vol. 61 Issue 12, p1104 

    The article cites a study of the trends of HIV prevalence in pregnant women in Bissau, Guinea-Bissau from 1987 to 2004 which aims to determine whether HIV prevalence levels had changed after the country's civil war of 1998-1999. Findings revealed that total HIV-1 prevalence grew from 0.0% in...

  • Superiority of 3 Over 2 Doses of Intermittent Preventive Treatment With Sulfadoxine- Pyrimethamine for the Prevention of Malaria During Pregnancy in Mali: A Randomized Controlled Trial. Maiga, Oumou M.; Kayentao, Kassoum; Traoré, Boubacar T.; Djimde, Abdoulaye; Traoré, Bouyagui; Traoré, Mouctar; Ongoiba, Aissata; Doumtabé, Didier; Doumbo, Safiatou; Traoré, Mamadou S.; Dara, Antoine; Guindo, Oumar; Karim, Diawara M.; Coulibaly, Siraman; Bougoudogo, Flabou; ter Kuile, Feiko O.; Danis, Martin; Doumbo, Ogobara K. // Clinical Infectious Diseases;8/1/2011, Vol. 53 Issue 3, p215 

    Background. In 2003, Mali introduced intermittent preventive therapy in pregnancy (ITPp) with sulfadoxinepyrimethamine (SP) for the control of malaria in pregnancy, consisting of 2 doses of SP given in the 2nd and 3rd trimester. This widely used regimen, although very effective, leaves many...

  • Optimal Management of HIV-Infected Women during Pregnancy and Delivery: An Audit of Compliance with Recommendations. Vandermaelen, Aline; Barlow, Patricia; Manigart, Yannick; Hainaut, Marc; Goetghebuer, Tessa; Levy, Jack; Gerard, Michèle; Rozenberg, Serge // Journal of Women's Health (15409996);Nov2009, Vol. 18 Issue 11, p1881 

    Background: The improvement in quality of life of HIV-infected patients and a reduced risk of vertical transmission have led to an increase in the desire for pregnancy among infected women. We assessed whether local recommendations were followed by HIV-infected mothers and their reasons for...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics