High risk of neutropenia in HIV-infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda
High risk of neutropenia in HIV-infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda
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DOI：
10.1086/529192
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发表时间：
2008-04-01
影响因子：
11.8
通讯作者：
Dorsey, Grant
中科院分区：
文献类型：
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作者：
Gasasira, Anne F.;Kamya, Moses R.;Dorsey, Grant
背景资料。基于青蒿素的联合疗法正在非洲迅速被用于治疗疟疾；然而，关于其在人类免疫缺陷病毒(HIV)感染人群中的安全性和有效性的数据有限。我们比较了乌干达感染艾滋病毒和未感染艾滋病毒的儿童队列的疟疾治疗结果，他们分别观察了18个月和29个月。使用青蒿琥酯加阿莫地喹治疗疟疾，并使用标准化指南评估结果。感染HIV的儿童按照现行指南接受甲氧苄氨嘧啶-磺胺甲恶唑预防和抗逆转录病毒治疗。26名感染艾滋病毒的参与者经历了35次疟疾发作，134名未感染艾滋病毒的儿童经历了258次疟疾发作，这项研究包括在内。12名感染艾滋病毒的儿童正在接受抗逆转录病毒治疗，其中11人正在接受齐多夫定治疗。疟疾治疗在感染艾滋病毒和未感染艾滋病毒的队列中都非常有效(28天内复发的风险分别为0%和3.6%)；然而，未感染艾滋病毒的儿童中疟疾复发的风险有增加的趋势(2.9%对13.2%；)。重要的是，感染艾滋病毒的儿童在青蒿琥酯加P=0.08阿莫地喹治疗14天后出现中性粒细胞减少的风险高于未感染艾滋病毒的儿童(45%比6%；P<；.001)。在未感染艾滋病毒的儿童中，所有中性粒细胞减少的发作都是轻度到中度的，在艾滋病毒感染的队列中，16%的中性粒细胞减少发作是严重的或危及生命的(中性粒细胞计数，
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%;). Importantly, the risk of neutropenia 14 days after initiation of treatment with artesunate plus P = .08 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,