Tolerability of Mefloquine Intermittent Preventive Treatment for Malaria in HIV-Infected Pregnant Women in Benin
Tolerability of Mefloquine Intermittent Preventive Treatment for Malaria in HIV-Infected Pregnant Women in Benin
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DOI：
10.1097/qai.0b013e3182615a58
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发表时间：
2012-09-01
影响因子：
3.6
通讯作者：
Cot, Michel
中科院分区：
文献类型：
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作者：
Denoeud-Ndam, Lise;Clement, Marie-Caroline;Cot, Michel
目的：研究甲氟喹间歇性预防治疗（MQ IPTp）对HIV感染孕妇和HIV阴性孕妇疟疾的耐受性。设计：前瞻性队列研究，比较来自贝宁2项临床试验的HIV阴性和HIV感染孕妇的样本。来自正在进行的PACOME试验的103名HIV感染妇女与来自以前试验的421名HIV阴性妇女进行了比较，这两项试验旨在评估以15 mg/kg剂量施用的MQ IPTp的功效和耐受性。描述性分析比较了根据HIV状态报告至少1种不良反应的女性比例。多水平Logistic回归分析确定了与报告每个MQ intake.Results的不良反应的概率相关的因素：头晕和呕吐是最常见的不良反应。HIV感染妇女的不良反应发生率较低（65%对78%，P = 0.009）。在多水平分析中，HIV感染[比值比（OR）= 0.23，95%置信区间（CI）= 0.08至0.61]降低了不良反应的风险，而可检测的病毒载量（OR = 2.46，95%CI = 1.07 ~ 5.66），首次摄入（与进一步摄入相比，OR = 5.26，95% CI = 3.70 - 7.14），年龄较大（OR = 1.62，95% CI = 1.13 ~ 2.32），文化程度越高（OR = 1.71，95% CI = 1.12 ~ 2.61）危险性越高。中度和严重的不良反应更频繁时，抗逆转录病毒药物开始伴随着MQ intake.Conclusions：这项研究提供了令人放心的数据使用MQ IPTp在HIV感染的孕妇。然而，频繁的不良反应仍然是中度的，并没有损害遵守MQ IPTp。在这一高危人群中，MQ可能是一个可接受的替代品，以防磺胺嘧啶-乙胺嘧啶失去其间歇性预防治疗的疗效。
Objective: To investigate the tolerability of mefloquine intermittent preventive treatment (MQ IPTp) for malaria in HIV-infected pregnant women compared with HIV-negative women.Design: Prospective cohort study comparing samples of HIV-negative and HIV- infected pregnant women from 2 clinical trials conducted in Benin.Methods: One hundred and three HIV-infected women from the ongoing PACOME trial were compared with 421 HIV-negative women from a former trial, both trials aiming to evaluate the efficacy and tolerability of MQ IPTp, administered at the dose of 15 mg/kg. Descriptive analysis compared the proportion of women reporting at least 1 adverse reaction, according to HIV status. Multilevel logistic regression identified factors associated with the probability of reporting an adverse reaction for each MQ intake.Results: Dizziness and vomiting were the most frequent adverse reactions. Adverse reactions were less frequent in HIV-infected women (65% versus 78%, P = 0.009). In multilevel analysis, HIV infection [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.08 to 0.61] decreased the risk for adverse reactions, whereas detectable viral load (OR = 2.46, 95% CI = 1.07 to 5.66), first intake (versus further intakes, OR = 5.26, 95% CI = 3.70 to 7.14), older age (OR = 1.62, 95% CI = 1.13 to 2.32), and higher education level (OR = 1.71, 95% CI = 1.12 to 2.61) increased the risk. Moderate and severe adverse reactions were more frequent when antiretrovirals were started concomitantly with a MQ intake.Conclusions: This study provides reassuring data on the use of MQ IPTp in HIV-infected pregnant women. However frequent, adverse reactions remained moderate and did not impair adherence to MQ IPTp. In this high-risk group, MQ might be an acceptable alternative in case sulfadoxine-pyrimethamine loses its efficacy for intermittent preventive treatment.