Impact of Trimethoprim-Sulfamethoxazole Prophylaxis on Falciparum Malaria Infection and Disease

摘要: In 2004, 2.3 million Africans died of HIV/AIDS and 3.1 acquired HIV infection, bringing the number persons living with in Africa to >25 [1]. Despite recent progress, antiretroviral therapy remains out reach for most HIV/AIDS. Cote D’Ivoire, trimethoprim-sulfamethoxazole (TS) prophylaxis reduced morbidity stage 2 or 3 mortality both tuberculosis [2, 3], leading UNAIDS recommend TS (1) HIV-infected adults children who either are symptomatic asymptomatic a CD4 cell count <500/mm3 (2) infants born mothers [4]. More-recent studies Uganda Zambia found that provided benefit [5, 6]. Trimethoprim pyrimethamine bind inhibit dihydrofolate reductase (DHFR), sulfamethoxazole sulfadoxine target dihydropteroate synthase(DHPS). Cross-resistance exists between trimethoprim [7–12], raising possibility use areas where malaria is endemic would select Plasmodium falciparum DHFR DHPS mutations confer resistance antimalarial combination sulfadoxine-pyrimethamine (SP). Prophylaxis was strongly rapidly selective rural Mali [13]. If similar selection occurs prophylaxis, it could accelerate development SP other antifolate antimalarials infection highly prevalent. Although malaria-treatment policies increasingly recommending newer therapies, will continue be used widely unless until more-expensive therapies made universally available. also recommended intermittent preventive treatment during pregnancy infancy, even face moderate [14, 15]. The widespread prevalent might hasten spread introduce promising under development. More importantly, receiving may more likely fail when they contract malaria. so, drugs than need treat develop Concerns about impact on efficacy have contributed reluctance implement Africa.