Malaria Journal | |
Incidence of malaria-related fever and morbidity due to Plasmodium falciparum among HIV1-infected pregnant women: a prospective cohort study in South Benin | |
Research | |
Djimon-Marcel Zannou1  Jocelyn Akakpo1  Aldric Afangnihoun2  Lucien Dossou-Gbété3  Komlan V Agossou4  Didier G Komongui5  Félix Atadokpédé6  Pierre-Marie Girard7  Michel Cot8  Lise Denoeud-Ndam8  Alexandre Duvignaud9  | |
[1] Centre de Traitement Ambulatoire, Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Bénin;Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin;Centre de Traitement Ambulatoire, Hôpital de zone de Suru Léré, Cotonou, Benin;Clinique Louis Pasteur, Cotonou, Bénin;Clinique Universitaire de Gynécologie et Obstétrique, Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Bénin;Service de Gynécologie-Obstétrique, Hôpital de la Mère et de l’Enfant Lagune, Cotonou, Bénin;Service de Médecine Interne, Hôpital d’Instruction des Armées, Cotonou, Bénin;Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France;Université Pierre et Marie Curie, Paris, France;UMR 216, Institut de Recherche pour le Développement, Paris, France;Université Paris Descartes, Paris, France;UMR 216, Institut de Recherche pour le Développement, Paris, France;Université Paris Descartes, Paris, France;Service de Médecine Tropicale, Clinical International Health, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; | |
关键词: Malaria; Pregnancy; HIV; Fever; Incidence rate; Attributable fraction; Morbidity; | |
DOI : 10.1186/1475-2875-13-255 | |
received in 2014-04-17, accepted in 2014-06-30, 发布年份 2014 | |
来源: Springer | |
【 摘 要 】
BackgroundMalaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa. Foetal and neonatal outcomes of this co-infection have been extensively studied. However, little is known about maternal morbidity due to clinical malaria in pregnancy, especially malaria-related fever, in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies.MethodsA cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever, as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women. Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery, with at least three scheduled visits during pregnancy. Confirmed malaria-related fever was defined as axillary temperature >37.5°C and a concomitant, positive, thick blood smear or rapid diagnostic test for Plasmodium falciparum. Suspected malaria-related fever was defined as an axillary temperature >37.5°C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation.ResultsIncidence rate for confirmed malaria-related fever was of 127.9 per 1,000 person-year (PY) (95% confidence interval (CI): 77.4-211.2). In multivariate analysis, CD4 lymphocytes (Relative Risk (RR) for a 50 cells/mm3 variation = 0.82; CI: 0.71-0.96), antiretroviral treatment started before inclusion (RR = 0.34; CI: 0.12-0.98) and history of symptomatic malaria in early pregnancy (RR = 7.10; CI: 2.35-22.49) were associated with the incidence of confirmed or suspected malaria-related fever. More than a half of participants with parasitaemia were symptomatic, with fever being the most common symptom. The crude fraction of febrile episodes attributable to malaria was estimated at 91%.ConclusionsThis work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women, with cellular immunodepression as a major determinant, and establishes the possible advantage offered by the early initiation of antiretroviral treatment.Trial registrationPACOME Study has been registered under the number NCT00970879.
【 授权许可】
CC BY
© Duvignaud et al.; licensee BioMed Central Ltd. 2014
【 预 览 】
Files | Size | Format | View |
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RO202311109117143ZK.pdf | 333KB | download |
【 参考文献 】
- [1]
- [2]
- [3]
- [4]
- [5]
- [6]
- [7]
- [8]
- [9]
- [10]
- [11]
- [12]
- [13]
- [14]
- [15]
- [16]
- [17]
- [18]
- [19]
- [20]
- [21]
- [22]
- [23]
- [24]
- [25]
- [26]
- [27]
- [28]
- [29]
- [30]
- [31]
- [32]