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Malaria Treatment Efficacy among People Living with HIV: The Role of Host and Parasite Factors

Identification of an effect of HIV-associated immunosuppression on response to antimalarial therapy would help guide management of malaria infection in areas of high HIV prevalence. Therefore, we conducted an observational study of people living with HIV infection in Blantyre, Malawi. Participants who developed malaria were treated with sulfadoxine–pyrimethamine (SP) and followed for 28 days. Molecular markers for SP resistance were measured. One hundred seventy-eight episodes of malaria were assessed. The 28-day cumulative treatment failure rate was 29.1%. In univariate analysis, CD4 cell count was not associated with treatment failure (hazard ratio 0.6, 95% confidence interval 0.3–1.2). Among children, the risk of treatment failure increased with infection with SP-resistant parasites and anemia. Decreased CD4 cell count was not associated with impaired response to antimalarial therapy or diminished ability to clear SP-resistant parasites, suggesting that acquired immunity to malaria is retained in the face of HIV-associated immunosuppression.

Received April 26, 2007. Accepted for publication June 11, 2007.

Acknowledgments: We are grateful to the Blantyre Malaria Project Ndirande Clinic team led by Mr. Feston Thumba and the study participants, with whom it has been a privilege to work. We also thank Drs. Grant Dorsey and Philip Rosenthal and Chris Dokomajilar for sharing the protocols for MSP-2 genotyping and assistance with interpretation of results.

Financial support: This study was funded by the National Institutes of Health (UO1 AI47858 and K25 AI59316).

^* Address correspondence to Miriam K. Laufer, Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, MD 21201. E-mail: mlaufer{at}medicine.umaryland.edu

Authors’ addresses: Miriam K. Laufer, Teresa Hsi, Lorraine Beraho, and Christopher V. Plowe, University of Maryland School of Medicine, 685 W. Baltimore St., HSF-1 Room 480, Baltimore, MD 21201, Telephone: +1 (410) 706-2491, Fax: +1 (410) 706-1204, E-mails: mlaufer{at}medicine.umaryland.edu, thsi{at}medicine.umaryland.edu, lberaho1{at}gmail.com, and cplowe{at}medicine.umaryland.edu. Joep J.G. van Oosterhout, University of Malawi College of Medicine, Department of Medicine, Private Bag 360, Blantyre, Malawi, Telephone: +265-1-870-202, E-mail: vanoosterhout{at}malawi.net. Phillip C. Thesing and Fraction K. Dzinjalamala, Blantyre Malaria Project, P.O. Box 32256, Blantyre 3, Malawi, Telephone: +265-1-675-021, Fax: +265-1-870-542, E-mails: fpthesing{at}medicine.umaryland.edu and fdzinjalamala{at}bmp.medcol.mw. Stephen M. Graham, Malawi–Liverpool–Wellcome Trust Programme of Clinical Tropical Research, P.O. Box 30096, Blantyre 3, Malawi, Telephone: +265-9-836-625, Fax: +265-1-875-774, E-mail: sgraham{at}mlw.medcol.mw. Terrie E.Taylor, Michigan State University, B309-B W. Fee Hall, Department of Internal Medicine, College of Osteopathic Medicine, East Lansing, MI 48824, Telephone: +1 (517) 353-8975, Fax: +1 (517) 432-1062, E-mail: taylort{at}msu.edu.

Reprint requests: Miriam K. Laufer, Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore St., HSF-1 Room 480, Baltimore, MD 21201, Telephone: +1 (410) 706-5333, Fax: +1 (410) 706-1204, E-mail: mlaufer{at}medicine.umaryland.edu.