CD4 count, viral load and parasite density of HIV positive individuals undergoing malaria treatment with dihydroartemisinin in Benin City, Edo state, Nigeria.

BACKGROUND & OBJECTIVES: A prospective study on 72 HIV infected and 33 HIV negative individuals undergoing malaria treatment with dihydroartemisinin (Cotecxin) was undertaken to compare CD4 cells count, viral load and parasite density at two time-points, a baseline visit and a 9-day post-treatment visit. METHODS: CD4 count and viral load of the subjects were estimated using Dynabeads T4-T8 Quantification Protocol (Dyneal Biotech, Norway) and Amplicor HIV-1 Monitor Test respectively (Roche, United Kingdom). RESULTS: There was a significant decrease in CD4 count at 9-day post-treatment when compared with baseline value (p < 0.05) in HIV infected individuals with CD4 < or =200 cells/microl. Also, the 9-day post-treatment viral load value was statistically higher than the baseline value (p < 0.05). In HIV positive patients with CD4 >200 cells/microl, a marked significant increase was obtained when the mean viral load at baseline was compared to the 9-day post-treatment visit value (p <0.05). The mean parasite density in HIV positive subjects was statistically higher when compared to that of HIV negative individuals at baseline and 9-day post-treatment (p < 0.05). INTERPRETATION & CONCLUSION: The study as such may not confirm the impact of malaria infection on progression to AIDS, incorporating effective malaria control in HIV management programmes may improve tremendously the quality of life of HIV infected individuals.

Open randomized study of artesunate-amodiaquine vs. chloroquine-pyrimethamine-sulfadoxine for the treatment of uncomplicated Plasmodium falciparum malaria in Nigerian children.

BACKGROUND: Artemisinin-based combination antimalarials are currently considered effective alternatives for the treatment of malaria in Africa, but there are few studies of such combinations in Nigerian children. We assessed the safety, treatment efficacy and effects on gametocyte carriage of the combination of artesunate plus amodiaquine and chloroquine plus pyrimethamine-sulfadoxine in children. METHODS: We evaluated 153 children who were aged 12 years or younger who had uncomplicated Plasmodium falciparum malaria. Patients were randomly assigned a combination of artesunate (4 mg/kg of body weight daily for 3 days) plus amodiaquine (30 mg/kg over 3 days), or chloroquine (25 mg/kg over 3 days) plus pyrimethamine-sulfadoxine (25 mg/kg of the sulfadoxine component at presentation). The primary endpoints were the proportions of children with adequate clinical and parasitological response, late parasitological failure, late clinical failure and early treatment failure. The parasitological cure rates on days 14-28 were also used as the primary endpoints. RESULTS: Both regimens were well tolerated; no child was withdrawn because of drug intolerance. All children treated with artesunate plus amodiaquine had adequate clinical and parasitological response (ACPR), while all but five children treated with chloroquine plus pyrimethamine-sulfadoxine had similar response. Fever clearance times were similar in the two treatment groups. However, the proportion of patients whose parasitaemia cleared by day 2 was significantly higher (100 vs. 50%, P = 0.00001) and parasite clearance was significantly faster (1.7 +/- 0.4 vs. 2.5 +/- 0.8 days, P = 0.0001) in children treated with artesunate plus amodiaquine. The cure rates on days 21 (100%vs. 94%, P = 0.03) and 28 (100%vs. 90%, P = 0.003) were also significantly higher in children treated with artesunate plus amodiaquine than in those treated with chloroquine plus pyrimethamine-sulfadoxine. Overall, a significantly higher proportion of children treated with chloroquine plus pyrimethamine-sulfadoxine carried gametocytes at least once during follow-up compared with those treated with artesunate plus amodiaquine [5 of 50 (10%) vs. 1 of 103 (0.97%), P = 0.01]. CONCLUSION: The combination of artesunate plus amodiaquine is therapeutically superior to a combination of chloroquine plus pyrimethamine-sulfadoxine, and significantly reduced gametocyte carriage following treatment.