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HIV-1 protease inhibitors and clinical malaria: a secondary analysis of the AIDS Clinical Trials Group A5208 study.
- Source :
-
Antimicrobial agents and chemotherapy [Antimicrob Agents Chemother] 2012 Feb; Vol. 56 (2), pp. 995-1000. Date of Electronic Publication: 2011 Nov 28. - Publication Year :
- 2012
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Abstract
- HIV-1 protease inhibitors (PIs) have antimalarial activity in vitro and in murine models. The potential beneficial effect of HIV-1 PIs on malaria has not been studied in clinical settings. We used data from Adult AIDS Clinical Trials Group A5208 sites where malaria is endemic to compare the incidence of clinically diagnosed malaria among HIV-infected adult women randomized to either lopinavir/ritonavir (LPV/r)-based antiretroviral therapy (ART) or to nevirapine (NVP)-based ART. We calculated hazard ratios and 95% confidence intervals. We conducted a recurrent events analysis that included both first and second clinical malarial episodes and also conducted analyses to assess the sensitivity of results to outcome misclassification. Among the 445 women in this analysis, 137 (31%) received a clinical diagnosis of malaria at least once during follow-up. Of these 137, 72 (53%) were randomized to LPV/r-based ART. Assignment to the LPV/r treatment group (n = 226) was not consistent with a large decrease in the hazard of first clinical malarial episode (hazard ratio = 1.11 [0.79 to 1.56]). The results were similar in the recurrent events analysis. Sensitivity analyses indicated the results were robust to reasonable levels of outcome misclassification. In this study, the treatment with LPV/r compared to NVP had no apparent beneficial effect on the incidence of clinical malaria among HIV-infected adult women. Additional research concerning the effects of PI-based therapy on the incidence of malaria diagnosed by more specific criteria and among groups at a higher risk for severe disease is warranted.
- Subjects :
- Adenine administration & dosage
Adenine analogs & derivatives
Adenine therapeutic use
Adult
Anti-HIV Agents administration & dosage
Deoxycytidine administration & dosage
Deoxycytidine analogs & derivatives
Deoxycytidine therapeutic use
Emtricitabine
Female
HIV Infections virology
HIV Protease Inhibitors administration & dosage
HIV-1 drug effects
Humans
Incidence
Lopinavir administration & dosage
Malaria diagnosis
Malaria drug therapy
Nevirapine administration & dosage
Nevirapine therapeutic use
Organophosphonates administration & dosage
Organophosphonates therapeutic use
Reverse Transcriptase Inhibitors administration & dosage
Reverse Transcriptase Inhibitors therapeutic use
Ritonavir administration & dosage
Tenofovir
Treatment Outcome
Anti-HIV Agents therapeutic use
HIV Infections complications
HIV Infections drug therapy
HIV Protease Inhibitors therapeutic use
Lopinavir therapeutic use
Malaria epidemiology
Ritonavir therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1098-6596
- Volume :
- 56
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Antimicrobial agents and chemotherapy
- Publication Type :
- Academic Journal
- Accession number :
- 22123685
- Full Text :
- https://doi.org/10.1128/AAC.05322-11