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|Title: ||High risk of neutropenia in HIV-Infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda.|
|Authors: ||Gasasira, Anne F.|
Kamya, Moses R.
Kalyango, Joan N.
Staedke, Sarah G.
Rosenthal, Philip J.
|Keywords: ||Malaria Treatment|
Artemisinin-based combination therapies
|Issue Date: ||22-Feb-2008 |
|Publisher: ||University of Chicago Press|
|Citation: ||Gasasira, A.F., Kamya, M.R., Achan, J., Mebrahtu, T., Kalyango, J.N., Ruel, T., Charlebois, E., Staedke, S.G., Kekitiinwa, A., Rosenthal, P.J., Havlir, D., Dorsey, G. (2008). High risk of neutropenia in HIV-Infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda. Clinical Infectious Diseases, 46(1)|
|Abstract: ||Background: Artemisinin-based combination therapies are rapidly being adopted for the treatment of malaria in Africa; however, there are limited data on their safety and efficacy among human immunodeficiency virus (HIV)–infected populations.
Methods: We compared malaria treatment outcomes between cohorts of HIV-infected and HIV-uninfected children in Uganda who were observed for 18 and 29 months, respectively. Malaria was treated with artesunate plus amodiaquine, and outcomes were assessed using standardized guidelines. HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis and antiretroviral therapy in accordance with current guidelines.
Results: Twenty-six HIV-infected participants experiencing 35 episodes of malaria and 134 HIV-uninfected children experiencing 258 episodes of malaria were included in the study. Twelve HIV-infected children were receiving antiretroviral therapy, 11 of whom were receiving zidovudine. Malaria treatment was highly efficacious in both the HIV-infected and HIV-uninfected cohorts (28-day risk of recrudescence, 0% and 3.6%, respectively); however, there was a trend towards increased risk of recurrent malaria among the HIV-uninfected children (2.9%vs. 13.2%; Pp.08). Importantly, the risk of neutropenia 14 days after initiation of treatment with artesunate plus amodiaquine was higher among HIV-infected children than among HIV-uninfected children (45% vs. 6%; P!.001). The severity of all episodes of neutropenia in HIV-uninfected children was mild to moderate, and 16% of episodes of neutropenia in the HIV-infected cohort were severe or life-threatening (neutrophil count, 750 cells/mm3). In the HIV-infected cohort, the risk of neutropenia was significantly higher among children who received antiretroviral therapy than among those who did not receive antiretroviral therapy (75% vs. 26%; Pp.001).
Conclusions: Artesunate plus amodiaquine was highly efficacious for malaria treatment in HIV-infected children but was associated with a high risk of neutropenia, especially in the context of concurrent antiretroviral use. Our findings highlight an urgent need for evaluation of alternative antimalarial therapies for HIV-infected individuals.|
|Appears in Collections:||Research Articles (Health-Sciences)|
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