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Am J Trop Med Hyg. 2018 Jan;98(1):67-70. doi: 10.4269/ajtmh.17-0462.

Prevalence of Asymptomatic Parasitemia and Gametocytemia in HIV-Infected Children on Differing Antiretroviral Therapy.

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Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.
Batson Children's Hospital, Department of Pediatrics (Division of Infectious Diseases) and Department of Microbiology, University of Mississippi Medical Center, Jackson, Mississippi.
Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, New York, New York.
Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland.
Kamuzu Central Hospital, University of North Carolina at Chapel Hill Lilongwe Project, Lilongwe, Malawi.
Cornell Clinical Trials Unit, Weill Cornell Medicine, New York, New York.
University of Maryland, Division of Malaria Research, Institute for Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
HYDAS World Health, Inc., Hummelstown, Pennsylvania.
Yale Schools of Public Health and Medicine, New Haven, Connecticut.
Department of Pediatrics, Division of Medical Genetics, University of Mississippi Medical Center, Batson Children's Hospital, Jackson, Mississippi.
HJF-DAIDS, Division of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to NIAID, NIH, DHHS, Bethesda, Maryland.
Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, University of Washington, and Fred Hutchinson Cancer Research Center, Seattle, Washington.
Division of Infectious Diseases and International Health, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.


Laboratory data and prior pediatric reports indicate that HIV protease inhibitor (PI)-based antiretroviral therapy (ARV) kills gametocytes and reduces rates of gametocytemia, but not asymptomatic parasitemia, in a high malaria-transmission area. To determine whether ARV regimen impacts these rates in areas with less-intense malaria transmission, we compared asymptomatic parasitemia and gametocytemia rates in HIV-infected children by ARV regimen in Lilongwe, Malawi, an area of low-to-moderate transmission intensity. HIV PI lopinavir-ritonavir (LPV-rtv) ARV- or non-nucleoside reverse transcriptase inhibitor nevirapine ARV-treated children did not differ in the rates of polymerase chain reaction-detected asymptomatic parasitemia (relative risk [RR] 0.43 95% confidence interval [CI] [0.16, 1.18], P value 0.10) or microscopically detected gametocytemia with LPV-rtv ARV during symptomatic malaria (RR 0.48 95% CI [0.22,1.04] P value 0.06). LPV-rtv ARV was not associated with reduced rates of asymptomatic parasitemia, or gametocytemia on days of symptomatic malaria episodes, in HIV-infected children. Larger studies should evaluate whether ARV impacts transmission.

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