CD4 T CELL ACTIVATION AS A PREDICTOR FOR TREATMENT FAILURE IN UGANDANS WITH PLASMODIUM FALCIPARUM MALARIA

MARK P. EGGENA Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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HEIDI HOPKINS Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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BANSON BARUGAHARE Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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MARTIN OKELLO Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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FRANCIS SSALI Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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PETER MUGYENYI Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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PHILIP J. ROSENTHAL Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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HUYEN CAO Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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GRANT DORSEY Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Joint Clinical Research Centre, Kampala, Uganda; California Department of Health Services, Richmond, California

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Host immunity plays an important role in response to antimalarial therapy but is poorly understood. To test whether T cell activation is a risk factor for antimalarial treatment failure, we studied CD4+ and CD8+ T cell activation in 31 human immunodeficiency virus–negative Ugandan patients 5–37 years of age who were treated for uncomplicated Plasmodium falciparum malaria. Increased CD4+ T cell activation, as indicated by co-expression of HLA-DR and CD38, was an independent risk factor for treatment failure (hazard ratio = 2.45, 95% confidence interval = 1.02–5.89, P = 0.05) in multivariate analysis controlling for age, baseline temperature, and pre-treatment parasite density. The results provide insight into the role of cellular immunity in response to antimalarial therapy and underscore the need to investigate the mechanisms behind immune activation.

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