Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women
Drugs to prevent malaria in HIV-positive pregnant women.
Don P Mathanga1,*, Olalekan A Uthman2, Jobiba Chinkhumba3
1 University of Malawi, Malaria Alert Center, College of Medicine, Blantyre, Malawi
2 Faculty of Health Sciences, Stellenbosch University, Centre for Evidence-Based Health Care, Tygerberg, Cape Town, South Africa
3 College of Medicine, University of Malawi, Malaria Alert Center, Blantyre, Malawi
Mathanga DP, Uthman OA, Chinkhumba J. Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD006689.
To read the full review please follow this link: DOI: 10.1002/14651858.CD006689.pub2.
Intermittent preventive treatment is the administration of a complete curative dose of an antimalarial medicine at predefined intervals during pregnancy (from the second trimester) regardless of whether or not the pregnant woman has malaria parasites. Intermittent preventive treatment for pregnant women, as is delivered at routine ante-natal care visits, is a World Health Organization (WHO) recommended policy and has been adopted in the majority of African malaria endemic countries. Since HIV increases the severity of malaria in pregnant women, it is important to evaluate the various drugs and doses needed to prevent malaria in HIV-positive pregnant women.
This review only identified two trials which compared the impact of using three or more doses of sulphadoxine-pyrimethamine to using only two doses. Using three or more doses was more effective at preventing the presence of malaria parasites in the placenta and in the peripheral blood of the pregnant woman than using the standard two doses only. Also, children born to HIV-positive pregnant women who used three or more doses of sulphadoxine-pyrimethamine weighed more than those born to mothers who used only the standard two doses.
Although more frequent doses of this drug are effective in preventing malaria, HIV-positive pregnant women with low CD4 count can not use the drug since the current policy requires that they use co-trimoxazole (Bactrim®) to prevent opportunistic infections. There is need, therefore, to investigate alternative drugs and regimens in preventing malaria in HIV-positive pregnant women.