Abstract
Abstract Background WHO recommends intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (S-P) in malaria-endemic areas. In pregnant women with HIV taking cotrimoxazole prophylaxis, IPTp with S-P is contraindicated due to the risk of adverse effects from combining two antifolate and sulfonamide drugs. The growing resistance of the malarial parasite to sulfa-based drugs adds to the problem. We performed a meta-analysis comparing IPTp with dihydroartemisinin-piperaquine (D-P) vs. placebo for malaria prevention in pregnant women with HIV. Methods We searched PubMed, Scopus, Cochrane Central, LILACS, and Malaria in Pregnancy Consortium Library databases for trials comparing IPTp with D-P vs. placebo in pregnant women with HIV. Outcomes of interest included placental malaria, maternal malaria, and adverse pregnancy outcomes. Statistical analysis was performed using R software. Heterogeneity was assessed using I2 statistics. The analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline. Results The systematic review identified 3 randomized controlled trials including 1,770 participants. Placental malaria (RR 0.65; 95%CI 0.48-0.87; p=0.004; I2=2%) at delivery was significantly lower in the D-P group compared with the placebo group. Maternal malaria (RR 0.63; 95%CI 0.29-1.40; p=0.258; I2=22%) at delivery showed no significant difference between the groups. However, a leave-one-out analysis excluding one study conducted during a low-transmission period found a significantly lower risk of maternal malaria (RR 0.47; 95%CI 0.23-0.96; p=0.039; I2=0%) in the D-P group. Adverse pregnancy outcomes like mother-to-child transmission of HIV (RR 1.53; 95%CI 0.25-9.35; p=0.646; I2=0%), spontaneous abortion (RR 1.80; 95%CI 0.60-5.42; p=0.296; I2=0%), stillbirth (RR 1.02; 95%CI 0.56-1.85; p=0.952; I2=0%), congenital anomaly (RR 0.90; 95%CI 0.33-2.43; p=0.830; I2=31%), preterm delivery (RR 1.05; 95%CI 0.56-1.94; p=0.885; I2=42%), and low birth weight (RR 1.13; 95%CI 0.87-1.48; p=0.352; I2=0%) were similar in both groups. Conclusion IPTp with D-P reduced the risk of placental malaria and maternal malaria at delivery in pregnant women with HIV. Adverse pregnancy outcomes were similar in both groups. Disclosures All Authors: No reported disclosures
Published Version
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