Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda.
<h4>Background</h4>Although WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. W...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0240838 |
| _version_ | 1819025992719532032 |
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| author | Philip Orishaba Joan N Kalyango Pauline Byakika-Kibwika Emmanuel Arinaitwe Bonnie Wandera Thomas Katairo Wani Muzeyi Hildah Tendo Nansikombi Alice Nakato Tobius Mutabazi Moses R Kamya Grant Dorsey Joaniter I Nankabirwa |
| author_facet | Philip Orishaba Joan N Kalyango Pauline Byakika-Kibwika Emmanuel Arinaitwe Bonnie Wandera Thomas Katairo Wani Muzeyi Hildah Tendo Nansikombi Alice Nakato Tobius Mutabazi Moses R Kamya Grant Dorsey Joaniter I Nankabirwa |
| author_sort | Philip Orishaba |
| collection | DOAJ |
| description | <h4>Background</h4>Although WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. We estimated the prevalence and factors associated with malaria parasitaemia among adults living with HIV attending hospital outpatient clinic before and after discontinuation of CTX prophylaxis.<h4>Methods</h4>Between March and April 2019, 599 participants aged 18 years and above, and attending Kitgum hospital HIV clinic in Uganda were enrolled in a cross study. A standardized questionnaire was administered and physical examination conducted. A finger-prick blood sample was collected for identification of malaria parasites by microscopy. The prevalence of parasitaemia was estimated and compared among participants on and those who had discontinued CTX prophylaxis, and factors associated with malaria parasitaemia assessed.<h4>Results</h4>Of the enrolled participants, 27 (4.5%) had malaria parasites and 452 (75.5%) had stopped CTX prophylaxis. Prevalence of malaria parasitaemia was significantly higher in participants who had stopped CTX prophylaxis (5.5% versus 1.4% p = 0.03) and increased with increasing duration since the discontinuation of prophylaxis. Compared to participants taking CTX, those who discontinued prophylaxis for 3-5 months and >5 months were more likely to have malaria parasites (adjusted prevalence ratio (aPR) = 1.64, 95% CI 0.37-7.29, p = 0.51, and aPR = 6.06, 95% CI 1.34-27.3, P = 0.02). Low CD4 count (< 250cells/mm3) was also associated with increased risk of having parasites (aPR = 4.31, 95% CI 2.13-8.73, p <0.001).<h4>Conclusion</h4>People from malaria endemic settings living with HIV have a higher prevalence of malaria parasitaemia following discontinuation of CTX compared to those still on prophylaxis. The risk increased with increasing duration since discontinuation of the prophylaxis. HIV patients should not discontinue CTX prophylaxis in areas of Uganda where the burden of malaria remains high. Other proven malaria control interventions may also be encouraged in HIV patients following discontinuation of CTX prophylaxis. |
| first_indexed | 2024-12-21T05:19:30Z |
| format | Article |
| id | doaj.art-a2fbc22d3e624372b1ffd75d0282357e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T05:19:30Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-a2fbc22d3e624372b1ffd75d0282357e2022-12-21T19:14:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-011511e024083810.1371/journal.pone.0240838Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda.Philip OrishabaJoan N KalyangoPauline Byakika-KibwikaEmmanuel ArinaitweBonnie WanderaThomas KatairoWani MuzeyiHildah Tendo NansikombiAlice NakatoTobius MutabaziMoses R KamyaGrant DorseyJoaniter I Nankabirwa<h4>Background</h4>Although WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. We estimated the prevalence and factors associated with malaria parasitaemia among adults living with HIV attending hospital outpatient clinic before and after discontinuation of CTX prophylaxis.<h4>Methods</h4>Between March and April 2019, 599 participants aged 18 years and above, and attending Kitgum hospital HIV clinic in Uganda were enrolled in a cross study. A standardized questionnaire was administered and physical examination conducted. A finger-prick blood sample was collected for identification of malaria parasites by microscopy. The prevalence of parasitaemia was estimated and compared among participants on and those who had discontinued CTX prophylaxis, and factors associated with malaria parasitaemia assessed.<h4>Results</h4>Of the enrolled participants, 27 (4.5%) had malaria parasites and 452 (75.5%) had stopped CTX prophylaxis. Prevalence of malaria parasitaemia was significantly higher in participants who had stopped CTX prophylaxis (5.5% versus 1.4% p = 0.03) and increased with increasing duration since the discontinuation of prophylaxis. Compared to participants taking CTX, those who discontinued prophylaxis for 3-5 months and >5 months were more likely to have malaria parasites (adjusted prevalence ratio (aPR) = 1.64, 95% CI 0.37-7.29, p = 0.51, and aPR = 6.06, 95% CI 1.34-27.3, P = 0.02). Low CD4 count (< 250cells/mm3) was also associated with increased risk of having parasites (aPR = 4.31, 95% CI 2.13-8.73, p <0.001).<h4>Conclusion</h4>People from malaria endemic settings living with HIV have a higher prevalence of malaria parasitaemia following discontinuation of CTX compared to those still on prophylaxis. The risk increased with increasing duration since discontinuation of the prophylaxis. HIV patients should not discontinue CTX prophylaxis in areas of Uganda where the burden of malaria remains high. Other proven malaria control interventions may also be encouraged in HIV patients following discontinuation of CTX prophylaxis.https://doi.org/10.1371/journal.pone.0240838 |
| spellingShingle | Philip Orishaba Joan N Kalyango Pauline Byakika-Kibwika Emmanuel Arinaitwe Bonnie Wandera Thomas Katairo Wani Muzeyi Hildah Tendo Nansikombi Alice Nakato Tobius Mutabazi Moses R Kamya Grant Dorsey Joaniter I Nankabirwa Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda. PLoS ONE |
| title | Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda. |
| title_full | Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda. |
| title_fullStr | Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda. |
| title_full_unstemmed | Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda. |
| title_short | Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda. |
| title_sort | increased malaria parasitaemia among adults living with hiv who have discontinued cotrimoxazole prophylaxis in kitgum district uganda |
| url | https://doi.org/10.1371/journal.pone.0240838 |
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