The epidemiological impact of HIV antiretroviral therapy on malaria in children.
The epidemiological impact of HIV antiretroviral therapy on malaria in children.
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DOI：
10.1097/qad.0000000000000550
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发表时间：
2015-02-20
期刊：
影响因子：
--
通讯作者：
Parikh S
中科院分区：
文献类型：
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作者：
Greenhalgh S;Ndeffo M;Galvani AP;Parikh S
本研究的目的是确定一线抗逆转录病毒治疗方案与艾滋病毒蛋白酶抑制剂的流行病学效果，以防止复发的儿童疟疾的艾滋病毒流行水平和疟疾传播强度的范围内遇到的撒哈拉以南非洲地区。疟疾传播的动态模型，开发使用的临床数据的蛋白酶抑制剂延长治疗后预防效果的抗疟治疗，蒿甲醚-苯芴醇，除了从文献中的参数估计。为了评估HIV蛋白酶抑制剂对儿童复发性疟疾健康负担的益处，我们构建了一个疟疾传播到HIV阳性和HIV阴性儿童的动态模型，并通过最近的临床试验数据进行参数化。然后在不同的疟疾传播和艾滋病毒流行情况下对该模型进行评估，以确定在蒿甲醚-苯芴醇治疗儿童疟疾的背景下艾滋病毒蛋白酶抑制剂的健康益处。在一系列疟疾传播环境中，比较低、中和高新生儿艾滋病毒流行率的情况，我们的动态模型预测，蒿甲醚-苯芴醇与基于艾滋病毒蛋白酶抑制剂的方案分别预防每1000名儿童每年0.03-0.10、5.2-13.0和25.5-65.8例疟疾发病率。此外，艾滋病毒蛋白酶抑制剂每年每1000名儿童可节省0.002-0.006、0.22-0.8、1.04-4.3残疾调整生命年。仅考虑感染艾滋病毒的儿童，艾滋病毒蛋白酶抑制剂每年可避免每1 000名儿童278至1 043例疟疾发病率。在艾滋病毒和疟疾共同流行的地区，使用基于艾滋病毒蛋白酶抑制剂的疗法作为艾滋病毒的一线抗逆转录病毒疗法，是减少艾滋病毒感染儿童疟疾复发的有效措施，蒿甲醚-苯芴醇是一线抗疟药。
The objective of this study is to determine the epidemiological effectiveness of a first-line antiretroviral regimen with HIV protease inhibitor for preventing recurrent malaria in children under the range of HIV prevalence levels and malaria transmission intensities encountered in sub-Saharan Africa. A dynamic model of malaria transmission was developed using clinical data on the protease inhibitor extended posttreatment prophylactic effect of the antimalarial treatment, artemether-lumefantrine, in addition to parameter estimates from the literature. To evaluate the benefits of HIV protease inhibitors on the health burden of recurrent malaria among children, we constructed a dynamic model of malaria transmission to both HIV-positive and HIV-negative children, parameterized by data from a recent clinical trial. The model was then evaluated under varying malaria transmission and HIV prevalence settings to determine the health benefits of HIV protease inhibitors in the context of artemether-lumefantrine treatment of malaria in children. Comparing scenarios of low, intermediate and high newborn HIV prevalence, in a range of malaria transmission settings, our dynamic model predicts that artemether-lumefantrine with HIV protease inhibitor based regimens prevents 0.03–0.10, 5.2–13.0 and 25.5–65.8 annual incidences of malaria per 1000 children, respectively. In addition, HIV protease inhibitors save 0.002–0.006, 0.22–0.8, 1.04–4.3 disability-adjusted life-years per 1000 children annually. Considering only HIV-infected children, HIV protease inhibitors avert between 278 and 1043 annual incidences of malaria per 1000 children. The use of HIV protease inhibitor based regimens as first-line antiretroviral therapy for HIV is an effective measure for reducing recurrent malaria among HIV-infected children in areas where HIV and malaria are coendemic, and artemether-lumefantrine is a first-line antimalarial.