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首页> 外文期刊>The American Journal of Tropical Medicine and Hygiene >Effect of cotrimoxazole prophylaxis taken by human immunodeficiency virus (HIV)-infected persons on the selection of sulfadoxine-pyrimethamine-resistant malaria parasites among HIV-uninfected household members.
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Effect of cotrimoxazole prophylaxis taken by human immunodeficiency virus (HIV)-infected persons on the selection of sulfadoxine-pyrimethamine-resistant malaria parasites among HIV-uninfected household members.

机译：感染人类免疫缺陷病毒（HIV）的人预防使用cotrimoxazole预防对未感染HIV的家庭成员中耐磺胺多辛-乙胺嘧啶的疟疾寄生虫的选择。

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摘要

The purpose of this prospective cohort study was to assess the effect of cotrimoxazole prophylaxis taken by human immunodeficiency virus (HIV)-infected persons on the selection of sulfadoxine-pyrimethamine (SP)-resistant malaria parasites among HIV-uninfected household members. A total of 2,567 HIV-uninfected persons from 605 households were followed and blood specimens were collected each time an episode of Plasmodium falciparum malaria was diagnosed. Study participants were living in households where HIV-infected persons were either taking (exposed) or not taking (unexposed) cotrimoxazole prophylaxis. From all malaria episodes diagnosed, 50% of the specimens were randomly selected and tested for the presence of five key mutations known to mediate resistance to SP (dihydrofolate reductase [dhfr] Asn-108, Ile-51, and Arg-59, and dihydropteroate synthase [dhps] Gly-437 and Glu-540). Plasmodium falciparum isolates were recovered from 163 specimens in the exposed households and 113 specimens in the unexposed households, with similar proportions containing the dhfr triple mutant (37% versus 45%; P = 0.18), the dhps double mutant (64% versus 62%; P = 0.81), and the dhfr/dhps quintuple mutant (30% versus 32%; P = 0.74). The HIV-uninfected persons living with HIV-infected household members taking cotrimoxazole prophylaxis had a lower incidence of malaria (incidence rate ratio [IRR] = 0.64, 95% confidence interval [CI] = 0.50-0.83, P = 0.001) and fewer malaria episodes due to parasites containing the dhfr/dhps quintuple mutant (IRR = 0.61, 95% CI = 0.41-0.91, P = 0.014). Cotrimoxazole prophylaxis taken by HIV-infected persons did not select for SP-resistant malaria parasites among HIV-uninfected household members, and was associated with a lower overall incidence of SP-resistant malaria among household members.
机译：这项前瞻性队列研究的目的是评估人类免疫缺陷病毒（HIV）感染者对cotrimoxazole的预防作用对未感染HIV的家庭成员中耐磺胺多辛-乙胺嘧啶（SP）的疟原虫的选择的影响。每次对605户家庭的2567例HIV未感染者进行跟踪，每次诊断出恶性疟原虫疟疾发作时都采集血液标本。研究参与者居住在艾滋病毒感染者正在服用（暴露）或未服用（未暴露）cotrimoxazole预防的家庭中。从所有诊断出的疟疾发作中，随机选择50％的标本并测试是否存在五个已知的介导SP抗性的关键突变（二氢叶酸还原酶[dhfr] Asn-108，Ile-51和Arg-59和双氢蝶呤）合酶[dhps] Gly-437和Glu-540）。从暴露家庭的163个标本和未暴露家庭的113个标本中回收了恶性疟原虫分离株，相似的比例包含dhfr三重突变体（37％对45％; P = 0.18），dhps双突变体（64％对62％）。 ; P = 0.81）和dhfr / dhps五元组突变体（30％对32％; P = 0.74）。接受科曲美唑预防的感染HIV的家庭成员的未感染HIV的人的疟疾发病率较低（发生率[IRR] = 0.64，95％置信区间[CI] = 0.50-0.83，P = 0.001），疟疾较少因含有dhfr / dhps五元组突变体的寄生虫而导致发作（IRR = 0.61，95％CI = 0.41-0.91，P = 0.014）。艾滋病毒感染者采取的复方新诺明预防措施未在未感染艾滋病毒的家庭成员中选择对SP抗药性疟疾的寄生虫，并且与家庭成员中对SP抗药性疟疾的总体发生率较低相关。

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