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Effect of antiretroviral therapy on malaria incidence in HIV-infected Ugandan adults

Kasirye, RP; Grosskurth, H; Munderi, P; Levin, J; Anywaine, Z; Nunn, A; Kamali, A; (2017) Effect of antiretroviral therapy on malaria incidence in HIV-infected Ugandan adults. AIDS , 31 (4) pp. 577-582. 10.1097/QAD.0000000000001344. Green open access

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Abstract

INTRODUCTION: Using the data of a trial on cotrimoxazole (CTX) cessation, we investigated the effect of different antiretroviral therapy (ART) regimens on the incidence of clinical malaria. METHODS: During the cotrimoxazole cessation trial (ISRCTN44723643), HIV-infected Ugandan adults with CD4þ at least 250 cells/ml were randomized to receive either CTX prophylaxis or placebo and were followed for a median of 2.5 years. Blood slides for malaria microscopy were examined at scheduled visits and at unscheduled visits when the participant felt unwell. CD4þ cell counts were done 6-monthly. Malaria was defined as fever with a positive blood slide. ART regimens were categorized as nucleoside reverse transcriptase inhibitor (NRTI) only, non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing or protease inhibitor containing. Malaria incidence was calculated using random effects Poisson regression to account for clustering of events. RESULTS: Malaria incidence in the three ART regimen groups was 9.9 (3.6-27.4), 9.3 (8.3-10.4), and 3.5 (1.6-7.6) per 100 person-years, respectively. Incidence on protease inhibitors was lower than that on the other regimens with the results just reaching significance (adjusted rate ratio 0.4, 95% confidence interval¼ 0.2–1.0, comparing with NNRTI regimens). Stratification by CTX/placebo use gave similar results, without evidence of an interaction between the effects of CTX/placebo use and ART regimen. There was no evidence of an interaction between ART regimen and CD4þ cell count. CONCLUSION: There was some evidence that protease inhibitor-containing ART regimens may be associated with a lower clinical malaria incidence compared with other regimens. This effect was not modified by CTX use or CD4þ cell count. The antimalarial properties of protease inhibitors may have clinical and public health importance.

Type: Article
Title: Effect of antiretroviral therapy on malaria incidence in HIV-infected Ugandan adults
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAD.0000000000001344
Publisher version: http://doi.org/10.1097/QAD.0000000000001344
Language: English
Additional information: Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: Antiretroviral therapy, cotrimoxazole, HIV, malaria
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL
URI: https://discovery.ucl.ac.uk/id/eprint/1538662
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