Volume 75, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


The purpose of this prospective cohort study was to assess the effect of cotrimoxazole prophylaxis taken by human immunodeficiency virus (HIV)–infected persons on the selection of sulfadoxine-pyrimethamine (SP)–resistant malaria parasites among HIV-uninfected household members. A total of 2,567 HIV-uninfected persons from 605 households were followed and blood specimens were collected each time an episode of malaria was diagnosed. Study participants were living in households where HIV-infected persons were either taking (exposed) or not taking (unexposed) cotrimoxazole prophylaxis. From all malaria episodes diagnosed, 50% of the specimens were randomly selected and tested for the presence of five key mutations known to mediate resistance to SP (dihydrofolate reductase [] Asn-108, Ile-51, and Arg-59, and dihydropteroate synthase [] Gly-437 and Glu-540). isolates were recovered from 163 specimens in the exposed households and 113 specimens in the unexposed households, with similar proportions containing the triple mutant (37% versus 45%; = 0.18), the double mutant (64% versus 62%; = 0.81), and the quintuple mutant (30% versus 32%; = 0.74). The HIV-uninfected persons living with HIV-infected household members taking cotrimoxazole prophylaxis had a lower incidence of malaria (incidence rate ratio [IRR] = 0.64, 95% confidence interval [CI] = 0.50–0.83, = 0.001) and fewer malaria episodes due to parasites containing the quintuple mutant (IRR = 0.61, 95% CI = 0.41–0.91, = 0.014). Cotrimoxazole prophylaxis taken by HIV-infected persons did not select for SP-resistant malaria parasites among HIV-uninfected household members, and was associated with a lower overall incidence of SP-resistant malaria among household members.


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  • Received : 13 Feb 2006
  • Accepted : 28 Mar 2006

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