High Risk of Neutropenia in HIV-Infected Children following Treatment with Artesunate plus Amodiaquine for Uncomplicated Malaria in Uganda

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dc.contributor.authorGasasira, Anne F.
dc.contributor.authorKamya, Moses R.
dc.contributor.authorAchan, Jane
dc.contributor.authorMebrahtu, Tsedal
dc.contributor.authorKalyango, Joan N.
dc.contributor.authorRuel, Theodore
dc.contributor.authorCharlebois, Edwin
dc.contributor.authorStaedke, Sarah G.
dc.contributor.authorKekitiinwa, Adeodata
dc.contributor.authorRosenthal, Philip J.
dc.contributor.authorHavlir, Diane
dc.contributor.authorDorsey, Grant
dc.date.accessioned2022-02-02T17:36:02Z
dc.date.available2022-02-02T17:36:02Z
dc.date.issued2008
dc.description.abstractArtemisinin-based combination therapies are rapidly being adopted for the treatment of malaria in Africa; however, there are limited data on their safety and efficacy among human immunodeficiency virus (HIV)–infected populations. Methods. We compared malaria treatment outcomes between cohorts of HIV-infected and HIV-uninfected children in Uganda who were observed for 18 and 29 months, respectively. Malaria was treated with artesunate plus amodiaquine, and outcomes were assessed using standardized guidelines. HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis and antiretroviral therapy in accordance with current guidelines. Results. Twenty-six HIV-infected participants experiencing 35 episodes of malaria and 134 HIV-uninfected children experiencing 258 episodes of malaria were included in the study. Twelve HIV-infected children were receiving antiretroviral therapy, 11 of whom were receiving zidovudine. Malaria treatment was highly efficacious in both the HIV-infected and HIV-uninfected cohorts (28-day risk of recrudescence, 0% and 3.6%, respectively); however, there was a trend towards increased risk of recurrent malaria among the HIV-uninfected children (2.9% vs. 13.2%; Pp.08). Importantly, the risk of neutropenia 14 days after initiation of treatment with artesunate plus amodiaquine was higher among HIV-infected children than among HIV-uninfected children (45% vs. 6%; P ! .001). The severity of all episodes of neutropenia in HIV-uninfected children was mild to moderate, and 16% of episodes of neutropenia in the HIV-infected cohort were severe or life-threatening (neutrophil count, !750 cells/ mm3). In the HIV-infected cohort, the risk of neutropenia was significantly higher among children who received antiretroviral therapy than among those who did not receive antiretroviral therapy (75% vs. 26%; Pp.001). Conclusions. Artesunate plus amodiaquine was highly efficacious for malaria treatment in HIV-infected children but was associated with a high risk of neutropenia, especially in the context of concurrent antiretroviral use. Our findings highlight an urgent need for evaluation of alternative antimalarial therapies for HIV-infected individuals.en_US
dc.identifier.citationGasasira, A. F., Kamya, M. R., Achan, J., Mebrahtu, T., Kalyango, J. N., Ruel, T., ... & Dorsey, G. (2008). High risk of neutropenia in HIV-infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda. Clinical infectious diseases, 46(7), 985-991. DOI: 10.1086/529192en_US
dc.identifier.other10.1086/529192
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/1780
dc.language.isoenen_US
dc.publisherClinical infectious diseasesen_US
dc.subjectNeutropeniaen_US
dc.subjectHIV-Infected Childrenen_US
dc.subjectTreatmenten_US
dc.subjectArtesunate plus Amodiaquineen_US
dc.subjectMalariaen_US
dc.subjectUgandaen_US
dc.titleHigh Risk of Neutropenia in HIV-Infected Children following Treatment with Artesunate plus Amodiaquine for Uncomplicated Malaria in Ugandaen_US
dc.typeArticleen_US
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