%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Denoeud Ndam, Lise
%A Zannou, D. M.
%A Fourcade, C.
%A Taron-Brocard, C.
%A Porcher, R.
%A Atadokpede, F.
%A Komongui, D. G.
%A Dossou-Gbete, L.
%A Afangnihoun, A.
%A Tuikue Ndam, Nicaise
%A Girard, P. M.
%A Cot, Michel
%T Cotrimoxazole prophylaxis versus mefloquine intermittent preventive treatment to prevent malaria in HIV-infected pregnant women : wo randomized controlled trials
%D 2014
%L fdi:010062046
%G ENG
%J Jaids.Journal of Acquired Immune Deficiency Syndromes
%@ 1525-4135
%K malaria during pregnancy ; mefloquine ; cotrimoxazole ; HIV ; randomized controlled trial
%M ISI:000335650300023
%N 2
%P 198-206
%R 10.1097/qai.0000000000000058
%U https://www.documentation.ird.fr/hor/fdi:010062046
%> https://www.documentation.ird.fr/intranet/publi/2014/06/010062046.pdf
%V 65
%W Horizon (IRD)
%X Background: Malaria during pregnancy has serious consequences that are worsened by HIV infection. Malaria preventive measures for HIV-infected pregnant women include cotrimoxazole (CTX) prophylaxis given to prevent HIV-related opportunistic infections and also protective against malaria, or intermittent preventive treatment (IPTp) with an antimalarial drug. Here, we present the first study evaluating CTX efficacy versus mefloquine (MQ)-IPTp, alone and in combination, in HIV-infected pregnant women. Methods: We conducted 2 randomized, open-label, noninferiority trials in Benin. In the CTX-mandatory trial, HIV-infected women with CD4 counts of <350 per cubic millimeter received CTX either alone or with MQ-IPTp (N = 292). In the CTX-not-mandatory trial (CD4 count >350/mm(3)), CTX was compared with MQ-IPTp (N = 140). In both the trials, the primary end point was microscopic placental parasitemia. Results: At delivery, 1 woman in each CTX-alone treatment group exhibited placental parasitemia, versus no women in the groups receiving MQ. CTX alone demonstrated noninferiority in the CTX-mandatory trial. However, polymerase chain reaction-detected placental parasitemia was markedly reduced in the CTX + MQ group compared with CTX alone (0/105 vs. 5/103, P = 0.03). Because of insufficient recruitment in the CTX-not-mandatory trial, noninferiority could not be conclusively assessed. Dizziness and vomiting of moderate intensity were reported by 34%-37% of women receiving MQ in both the trials, versus 0%-3% in CTX groups (P < 0.0001). No serious adverse events related to these drugs were found. Conclusions: CTX alone provided adequate protection against malaria in HIV-infected pregnant women, although MQ-IPTp showed higher efficacy against placental infection. Although more frequently associated with dizziness and vomiting, MQ-IPTp may be an effective alternative given concerns about parasite resistance to CTX.
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