EFFICACY OF SULFADOXLNE-PYRIMETHAMINE FOR PREVENTION OF PLACENTAL MALARIA IN AN AREA OF KENYA WITH A HIGH PREVALENCE OF MALARIA AND HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

A fever case management (CM) approach using sulfadoxine-pyrimethamine (SP) was compared with two presumptive intertmittent SP treatment regi mens in the second and third trimesters in pregnant primigravidae and secundigravidae in an area of intense Plasmodium falciparum malaria tr ansmission in western Kenya. The investigation evaluated efficacy of t he antimalarial regimens for prevention of placental malaria and exami ned the effect of human immunodeficiency virus (HIV) infection on anti malarial drug efficacy and adverse drug reactions. Twenty seven percen t (93 of 343) of pregnant women in the CM group had placental malaria compared with 12% (38 of 330; P < 0.001) of women who received two dos es of SP and compared with 9% (28 of 316; P < 0.001) of women who rece ived monthly SP. Fourteen percent (49 of 341) of women in the CM group delivered low birth weight (LBW) infants compared with 8% (27 of 325; P = 0.118) of women who received two doses of SP and compared with 8% (26 of 331; P = 0.078) of women who received monthly SP. Seven percen t (7 of 99) of the HIV-negative women on the two-dose SP regimen had p lacental malaria compared with 25% (10 of 39; P = 0.007) of HIV-positi ve women on the same regimen; the rate of placental malaria in HIV-pos itive women was reduced to 7% (2 of 28; P = 0.051) for women on the mo nthly SP regimen. Less than 2% of women reported adverse drug reaction s, with no statistically significant differences between HIV-positive and HIV-negative women. Intermittent treatment with SP is safe and eff icacious for the prevention of placental malaria in pregnant primigrav idae and secundigravidae in sub-Saharan Africa. While a two-dose SP re gimen may be effective in areas with low HIV seroprevalence, administr ation of SP monthly during the second and third trimesters of pregnanc y should be considered in areas of high HIV seroprevalence to prevent the effects of maternal malaria on the newborn.