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|Title: ||Low prevalence of plasmodium falciparum antigenaemia among asymptomatic HAARTtreated adults in an urban cohort in Uganda|
|Authors: ||Nakanjako, Damalie|
Kiragga, Agnes N.
Kyabayinze, Daniel J.
Kamya, Moses R.
Artemisinin-based combination therapy (ACT)
Highly Active Anti-retroviral Therapy (HAART)
People living with HIV (PLHIV).
|Issue Date: ||2011 |
|Publisher: ||BioMed Central|
|Citation: ||Nakanjako, D., Kiragga, A., Castelnuovo, B., Kyabayinze, D.J., Kamya, M.R. (2011). Low prevalence of Plasmodium falciparum antigenaemia among asymptomatic HAART treated adults in an urban cohort in Uganda. Malaria Journal, 10(66).|
|Abstract: ||Background: Presumptive treatment of malaria is common practice in malaria endemic resource-limited settings.
With the changing epidemiology of malaria and the introduction of artemisinin-based combination therapy (ACT),
there is increasing need for parasite-based malaria case management to prevent unnecessary use of anti-malarial
medicines, improve patient care in parasite-positive patients and identify parasite-negative patients in whom
another diagnosis must be sought. Although parasitological confirmation by microscopy or alternatively by malaria
rapid diagnostic tests (RDTs) is recommended in all patients suspected of malaria before treatment, gaps remain in
the implementation of this policy in resource-limited settings. There is need to evaluate the use of RDTs among
highly active anti-retroviral therapy (HAART)-treated people living with HIV (PLHIV).
Methods: Within an urban prospective observational research cohort of 559 PLHIV initiated on HAART and
cotrimoxazole prophylaxis between April, 2004 and April, 2005, 128 patients with sustained HIV-RNA viral load <
400 copies/ml for four years were evaluated, in a cross-sectional study, for asymptomatic malaria infection using a
histidine-rich protein-2 (HRP-2) RDT to detect Plasmodium falciparum antigen in peripheral blood. Patients with
positive RDT results had microscopy performed to determine the parasite densities and were followed for clinical
signs and symptoms during the subsequent six months.
Results: Of the 128 asymptomatic patients screened, only 5 (4%) had asymptomatic P. falciparum antigenaemia. All
the patients with positive HRP2 RDT results showed malaria parasites on thick film with parasite densities ranging
from 02-15 malaria parasites per high power field. None of the patients with positive RDT results reported signs
and symptoms of malaria infection during the subsequent six months.
Conclusions: In an urban area of low to moderate stable malaria transmission, there was low HRP2 P. falciparum
antigenaemia among PLHIV after long-term HAART and cotrimoxazole prophylaxis. Parasite-based malaria diagnosis
(PMD) is recommended among PLHIV that are on long-term anti-retroviral therapy. RDTs should be utilized to
expand PMD in similar settings where microscopy is unavailable.|
|Appears in Collections:||Research Articles (Health-Sciences)|
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