Prevalence of Asymptomatic Parasitemia and Gametocytemia among HIV-Infected Ugandan Children Randomized to Receive Different Antiretroviral Therapies

Gloria Ikilezi Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Jane Achan Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Abel Kakuru Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Theodore Ruel Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Edwin Charlebois Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Tamara D. Clark Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Philip J. Rosenthal Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Diane Havlir Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Moses R. Kamya Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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Grant Dorsey Infectious Diseases Research Collaboration, Kampala, Uganda; Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda; Department of Pediatrics, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, San Francisco General Hospital, University of California, San Francisco, California; Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda

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In a recent randomized controlled trial, the use of protease inhibitor (PI)-based antiretroviral therapy (ART) was associated with a significantly lower incidence of malaria compared with non-nucleoside reverse transcriptase inhibitor-based ART in a cohort of human immunodeficiency virus-infected Ugandan children living in an area of high malaria transmission intensity. In this report, we compared the prevalence of asymptomatic parasitemia and gametocytemia using data from the same cohort. The prevalence of asymptomatic parasitemia did not differ between the two ART treatment arms. The PI-based arm was associated with a lower risk of gametocytemia at the time of diagnosis of malaria (6.6% versus 14.5%, P = 0.03) and during the 28 days after malaria diagnosis (3.4% versus 6.5%, P = 0.04). Thus, in addition to decreasing the incidence of malaria, the use of PI-based ART may lower transmission, as a result of a decrease in gametocytemia, in areas of high malaria transmission intensity.

Author Notes

* Address correspondence to Grant Dorsey, Parnassus Avenue, Box 0811, San Francisco, CA 94143. E-mail: gdorsey@medsfgh.ucsf.edu

Financial support: This work was supported by the National Institutes of Health (P01 HD059454). The study drug, Aluvia, was donated by Abbott Laboratories.

Authors' addresses: Gloria Ikilezi and Abel Kakuru, Infectious Diseases Research Collaboration, Kampala, Uganda, E-mails: gloria2k2@yahoo.co.uk and abelkakuru@gmail.com. Jane Achan, Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: achanj@yahoo.co.uk. Theodore Ruel, Department of Pediatrics, University of California, San Francisco, CA, E-mail: RuelT@peds.ucsf.edu. Edwin Charlebois, Tamara D. Clark, Philip J. Rosenthal, Diane Havlir, and Grant Dorsey, Department of Medicine, University of California, San Francisco, CA, E-mails: Edwin.Charlebois@ucsf.edu, tclark@medsfgh.ucsf.edu, prosenthal@medsfgh.ucsf.edu, dhavlir@php.ucsf.edu, and gdorsey@medsfgh.ucsf.edu. Moses R. Kamya, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda, E-mail: mkamya@infocom.co.ug.

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