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Meta-Analysis
. 2024 Sep 26;9(9):CD006689.
doi: 10.1002/14651858.CD006689.pub3.

Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women

Clara Pons-Duran  1   2 , Myrte J Wassenaar  1 , Koffi Emmanuel Yovo  3   4 , Clara Marín-Carballo  1 , Valérie Briand  5   6 , Raquel González  1   7   8
Affiliations
Meta-Analysis

Intermittent preventive treatment regimens for malaria in HIV-positive pregnant women

Clara Pons-Duran et al. Cochrane Database Syst Rev. .

Abstract

Background: Malaria and HIV infection overlap geographically in sub-Saharan Africa and share risk factors. HIV infection increases malaria's severity, especially in pregnant women. The World Health Organization (WHO) recommends intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) for pregnant women living in areas of stable malaria transmission. However, HIV-positive women on daily cotrimoxazole prophylaxis (recommended for prevention of opportunistic infections in people with HIV) cannot receive SP due to adverse drug interactions, so malaria prevention in this vulnerable population currently relies on daily cotrimoxazole prophylaxis alone. This review is based on a new protocol and provides an update to the 2011 Cochrane Review that evaluated alternative drugs for IPTp to prevent malaria in HIV-positive women.

Objectives: To compare the safety and efficacy of intermittent preventive treatment regimens for malaria prevention in HIV-positive pregnant women.

Search methods: We searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registries to 31 January 2024. To identify relevant additional studies or unpublished work, we checked references and contacted study authors and other researchers working on malaria and HIV.

Selection criteria: We included randomized controlled trials (RCTs) comparing any intermittent preventive treatment regimen for preventing malaria in HIV-positive pregnant women against daily cotrimoxazole prophylaxis alone, placebo, current or previous standard of care, or combinations of these options. By 'standard of care' we refer to the country's recommended drug regimen to prevent malaria in pregnancy among HIV-positive women, or the treatment that a trial's research team considered to be the standard of care.

Data collection and analysis: Review authors, in pairs, independently screened all records identified by the search strategy, applied inclusion criteria, assessed risk of bias in included trials, and extracted data. We contacted trial authors when additional information was required. We presented dichotomous outcomes using risk ratios (RRs), count outcomes as incidence rate ratios (IRRs), and continuous outcomes as mean differences (MDs). We presented all measures of effect with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach for what we considered to be the main comparisons and outcomes.

Main results: We included 14 RCTs, with a total of 4976 HIV-positive pregnant women initially randomized. All trials assessed the efficacy and safety of one antimalarial used as IPTp (mefloquine, dihydroartemisinin/piperaquine, SP, or azithromycin) with or without daily cotrimoxazole, compared to daily cotrimoxazole alone, placebo, or a standard of care regimen. We grouped the trials into nine comparisons. Our main comparison evaluated the current standard of care (daily cotrimoxazole) with another drug regimen (mefloquine or dihydroartemisinin/piperaquine) versus daily cotrimoxazole with or without placebo. In this comparison, two trials evaluated mefloquine and three evaluated dihydroartemisinin/piperaquine. We conducted meta-analyses that included trials evaluating dihydroartemisinin/piperaquine plus cotrimoxazole, and trials that evaluated mefloquine plus cotrimoxazole, as we considered there to be no qualitative or quantitative heterogeneity among trials for most outcomes. We considered drug-related adverse events and HIV-related outcomes to be drug-specific. Daily cotrimoxazole prophylaxis plus another drug regimen (mefloquine or dihydroartemisinin/piperaquine) probably results in lower risk of maternal peripheral parasitaemia at delivery (RR 0.62, 95% CI 0.41 to 0.95; 2406 participants, 5 trials; moderate-certainty evidence). It results in little or no difference in maternal anaemia cases at delivery (RR 0.98, 95% CI 0.90 to 1.07; 2417 participants, 3 trials; high-certainty evidence). It probably results in a decrease in placental malaria measured by blood smear (RR 0.54, 95% CI 0.31 to 0.93; 1337 participants, 3 trials; moderate-certainty evidence), and probably results in little or no difference in low birth weight (RR 1.16, 95% CI 0.95 to 1.41; 2915 participants, 5 trials; moderate-certainty evidence). There is insufficient evidence to ascertain whether daily cotrimoxazole prophylaxis plus another drug regimen affects the risk of cord blood parasitaemia (RR 0.27, 95% CI 0.04 to 1.64; 2696 participants, 5 trials; very low-certainty evidence). Daily cotrimoxazole prophylaxis plus another drug regimen probably results in little or no difference in foetal loss (RR 1.03, 95% CI 0.73 to 1.46; 2957 participants, 5 trials; moderate-certainty evidence), and may result in little or no difference in neonatal mortality (RR 1.21, 95% CI 0.68 to 2.14; 2706 participants, 4 trials; low-certainty evidence). Due to the probability of an increased risk of mother-to-child HIV transmission and some adverse drug effects noted with mefloquine, we also looked at the results for dihydroartemisinin/piperaquine specifically. Dihydroartemisinin/piperaquine plus daily contrimoxazole probably results in little to no difference in maternal peripheral parasitaemia (RR 0.59, 95% CI 0.31 to 1.11; 1517 participants, 3 trials; moderate-certainty evidence) or anaemia at delivery (RR 0.95, 95% CI 0.82 to 1.10; 1454 participants, 2 trials; moderate-certainty evidence), but leads to fewer women having placental malaria when measured by histopathologic analysis (RR 0.67, 95% CI 0.50 to 0.90; 1570 participants, 3 trials; high-certainty evidence). The addition of dihydroartemisinin/piperaquine to daily cotrimoxazole probably made little to no difference to rates of low birth weight (RR 1.13, 95% CI 0.87 to 1.48; 1695 participants, 3 trials), foetal loss (RR 1.14, 95% CI 0.68 to 1.90; 1610 participants, 3 trials), or neonatal mortality (RR 1.03, 95% CI 0.39 to 2.72; 1467 participants, 2 trials) (all moderate-certainty evidence). We found low-certainty evidence of no increased risk of gastrointestinal drug-related adverse events (RR 1.42, 95% CI 0.51 to 3.98; 1447 participants, 2 trials) or mother-to-child HIV transmission (RR 1.54, 95% CI 0.26 to 9.19; 1063 participants, 2 trials).

Authors' conclusions: Dihydroartemisinin/piperaquine and mefloquine added to daily cotrimoxazole seem to be efficacious in preventing malaria infection in HIV-positive pregnant women compared to daily cotrimoxazole alone. However, increased risk of HIV transmission to the foetus and poor drug tolerability may be barriers to implementation of mefloquine in practice. In contrast, the evidence suggests that dihydroartemisinin/piperaquine does not increase the risk of HIV mother-to-child transmission and is well tolerated.

Trial registration: ClinicalTrials.gov NCT02524444 NCT02527005 NCT04158713 NCT00970879 NCT00126906 NCT00811421 NCT03671109 NCT00270530 NCT01746199 NCT00711906 NCT00209781 NCT02282293 NCT00131235 NCT00132535 NCT00164255 NCT03431168.

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Conflict of interest statement

CPD is author of a trial included in this review (González 2024), but was not involved in assessing the eligibility, risk of bias assessment, or analyses of this study. She has no known conflicts of interest.

CMC has no known conflicts of interest.

KEY has no known conflicts of interest.

VB is author of a trial that is included in this review (Manirakiza 2021), but was not involved in assessing the eligibility, risk of bias assessment, or analyses of this study. VB was Chair of the Data and Safety Monitoring Board of another trial included in this review (González 2024). She has no known conflicts of interest.

MJW has no known conflicts of interest.

RG is an author on two trials that are included in this review (González 2014; González 2024), but was not involved in assessing the eligibility, in risk of bias assessment, or analyses of these studies. She has no known conflicts of interest.

Figures

1
1
Study flow diagram
2
2
Risk of bias summary of individual included studies
3
3
Risk of bias summary across included studies
1.1
1.1. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 1: Maternal peripheral parasitaemia at delivery (amplification techniques)
1.2
1.2. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 2: Maternal peripheral parasitaemia at delivery (microscopy)
1.3
1.3. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 3: Maternal anaemia at delivery (< 11 g/dL)
1.4
1.4. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 4: Placental malaria (any test)
1.5
1.5. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 5: Placental malaria (blood smear)
1.6
1.6. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 6: Placental malaria (amplification techniques)
1.7
1.7. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 7: Placental malaria (histopathologic analysis)
1.8
1.8. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 8: Maternal peripheral parasitaemia during pregnancy (any test)
1.9
1.9. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 9: Clinical malaria episodes during pregnancy
1.10
1.10. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 10: Mean haemoglobin at delivery (in g/dL)
1.11
1.11. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 11: Maternal severe anaemia at delivery (< 7 g/dL)
1.12
1.12. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 12: Low birth weight (less than 2500 g)
1.13
1.13. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 13: Mean birth weight (g)
1.14
1.14. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 14: Cord blood parasitaemia (blood smear)
1.15
1.15. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 15: Cord blood parasitaemia (loop‐mediated isothermal amplification)
1.16
1.16. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 16: Prematurity
1.17
1.17. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 17: Severe adverse events during pregnancy
1.18
1.18. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 18: Foetal loss
1.19
1.19. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 19: Congenital malformations
1.20
1.20. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 20: Maternal mortality
1.21
1.21. Analysis
Comparison 1: Daily cotrimoxazole (CTXp) with any other drug regimen (mefloquine (MQ) or dihydroartemisinin‐piperaquine (DHA‐PPQ)) versus CTXp with or without placebo (current standard of care), Outcome 21: Neonatal mortality
2.1
2.1. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 1: Maternal peripheral parasitaemia at delivery (polymerase chain reaction)
2.2
2.2. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 2: Maternal anaemia at delivery (< 9.5 g/dL)
2.3
2.3. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 3: Placental malaria (blood smear)
2.4
2.4. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 4: Placental malaria (polymerase chain reaction)
2.5
2.5. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 5: Clinical malaria episodes during pregnancy
2.6
2.6. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 6: Mean haemoglobin at delivery (in g/dL)
2.7
2.7. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 7: Maternal severe anaemia at delivery
2.8
2.8. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 8: Low birth weight (< 2500 g)
2.9
2.9. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 9: Mean birth weight (g)
2.10
2.10. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 10: Cord blood parasitaemia
2.11
2.11. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 11: Prematurity
2.12
2.12. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 12: Severe adverse events during pregnancy
2.13
2.13. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 13: Foetal loss
2.14
2.14. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 14: Congenital malformations
2.15
2.15. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 15: Maternal mortality
2.16
2.16. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 16: Neonatal mortality
2.17
2.17. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 17: Adverse events: headache
2.18
2.18. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 18: Adverse events: vomiting
2.19
2.19. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 19: Adverse events: dizziness
2.20
2.20. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 20: Adverse events: fatigue/weakness
2.21
2.21. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 21: Mother‐to‐child transmission of HIV
2.22
2.22. Analysis
Comparison 2: Mefloquine (MQ) plus daily cotrimoxazole (CTXp) versus CTXp, Outcome 22: Undetectable viral load
3.1
3.1. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 1: Maternal peripheral parasitaemia at delivery (amplification techniques)
3.2
3.2. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 2: Maternal peripheral parasitaemia at delivery (microscopy)
3.3
3.3. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 3: Maternal anaemia at delivery (< 11g/dL)
3.4
3.4. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 4: Placental malaria (any test)
3.5
3.5. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 5: Placental malaria (histopathologic analysis)
3.6
3.6. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 6: Maternal peripheral parasitaemia during pregnancy (any test)
3.7
3.7. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 7: Clinical malaria episodes during pregnancy
3.8
3.8. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 8: Mean haemoglobin at delivery (g/dL)
3.9
3.9. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 9: Maternal severe anaemia at delivery (< 7g/dL)
3.10
3.10. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 10: Low birth weight (< 2500 g)
3.11
3.11. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 11: Mean birth weight (g)
3.12
3.12. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 12: Cord blood parasitaemia (microscopy)
3.13
3.13. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 13: Cord blood parasitaemia (loop‐mediated isothermal amplification)
3.14
3.14. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 14: Prematurity
3.15
3.15. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 15: Severe adverse events during pregnancy
3.16
3.16. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 16: Foetal loss
3.17
3.17. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 17: Congenital malformations
3.18
3.18. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 18: Maternal mortality
3.19
3.19. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 19: Neonatal mortality
3.20
3.20. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 20: Adverse events: headache
3.21
3.21. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 21: Adverse events: gastrointestinal disorders after first IPTp dose
3.22
3.22. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 22: Adverse events: dizziness after first IPTp dose
3.23
3.23. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 23: Mother‐to‐child transmission of HIV
3.24
3.24. Analysis
Comparison 3: Dihydroartemisinin‐piperaquine (DHA‐PPQ) plus daily cotrimoxazole (CTXp) versus placebo plus CTXp, Outcome 24: Undetectable HIV viral load at delivery
4.1
4.1. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 1: Maternal peripheral parasitaemia at delivery (blood smear)
4.2
4.2. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 2: Maternal anaemia at delivery (haemoglobin < 11 g/dL)
4.3
4.3. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 3: Placental malaria (blood smear)
4.4
4.4. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 4: Clinical malaria episodes during pregnancy
4.5
4.5. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 5: Maternal haemoglobin at delivery (in g/dL)
4.6
4.6. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 6: Low birth weight (< 2500 g)
4.7
4.7. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 7: Mean birth weight (in kg)
4.8
4.8. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 8: Cord blood parasitaemia
4.9
4.9. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 9: Prematurity
4.10
4.10. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 10: Severe adverse events during pregnancy
4.11
4.11. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 11: Spontaneous abortion
4.12
4.12. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 12: Stillbirth
4.13
4.13. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 13: Maternal mortality
4.14
4.14. Analysis
Comparison 4: Monthly sulfadoxine‐pyrimethamine (SP) versus two doses of SP, Outcome 14: Neonatal mortality
5.1
5.1. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 1: Maternal peripheral parasitaemia during pregnancy
5.2
5.2. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 2: Maternal anaemia during delivery
5.3
5.3. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 3: Placental malaria (histology)
5.4
5.4. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 4: Placental malaria (microscopy or polymerase chain reaction)
5.5
5.5. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 5: Clinical malaria episodes during pregnancy
5.6
5.6. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 6: Maternal haemoglobin level at delivery (in g/dL)
5.7
5.7. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 7: Low birth weight (< 2500 g)
5.8
5.8. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 8: Mean birth weight (in grams)
5.9
5.9. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 9: Cord blood parasitaemia (rapid diagnostic test)
5.10
5.10. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 10: Congenital malaria
5.11
5.11. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 11: Prematurity
5.12
5.12. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 12: SAEs during pregnancy
5.13
5.13. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 13: Spontaneous abortion
5.14
5.14. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 14: Stillbirth
5.15
5.15. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 15: Congenital malformations
5.16
5.16. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 16: Maternal mortality
5.17
5.17. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 17: Neonatal mortality
5.18
5.18. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 18: Infant mortality
5.19
5.19. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 19: Adverse events: rash
5.20
5.20. Analysis
Comparison 5: Daily cotrimoxazole (CTXp) versus three doses of sulfadoxine‐pyrimethamine (SP), Outcome 20: Mother‐to‐child transmission of HIV
6.1
6.1. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 1: Maternal peripheral parasitemia at delivery (blood smear)
6.2
6.2. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 2: Placental malaria (blood smear)
6.3
6.3. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 3: Low birth weight (< 2500 g)
6.4
6.4. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 4: Prematurity
6.5
6.5. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 5: Adverse events: nausea
6.6
6.6. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 6: Adverse events: headache
6.7
6.7. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 7: Adverse events: vomiting
6.8
6.8. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 8: Adverse events: dizziness
6.9
6.9. Analysis
Comparison 6: Mefloquine (MQ) versus sulfadoxine‐pyrimethamine (SP), Outcome 9: Adverse events: gastric pain
7.1
7.1. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 1: Maternal peripheral parasitaemia at delivery (blood smear)
7.2
7.2. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 2: Maternal anaemia at delivery
7.3
7.3. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 3: Placental malaria (blood smear)
7.4
7.4. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 4: Clinical malaria episodes during pregnancy
7.5
7.5. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 5: Low birth weight (< 2.5 kg)
7.6
7.6. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 6: Mean birth weight (in kg)
7.7
7.7. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 7: Prematurity
7.8
7.8. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 8: SAEs during pregnancy
7.9
7.9. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 9: Spontaneous abortion
7.10
7.10. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 10: Stillbirth
7.11
7.11. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 11: Congenital malformations
7.12
7.12. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 12: Maternal mortality
7.13
7.13. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 13: Neonatal mortality
7.14
7.14. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 14: Adverse events: headache
7.15
7.15. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 15: Adverse events: nausea
7.16
7.16. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 16: Adverse events: vomiting
7.17
7.17. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 17: Adverse events: dizziness
7.18
7.18. Analysis
Comparison 7: Azithromycin (AZ) versus sulfadoxine‐pyrimethamine (SP), Outcome 18: Adverse events: abdominal pain
8.1
8.1. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 1: Maternal peripheral parasitaemia at delivery (polymerase chain reaction)
8.2
8.2. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 2: Maternal anaemia at delivery
8.3
8.3. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 3: Placental malaria (polymerase chain reaction)
8.4
8.4. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 4: Placental malaria (blood smear)
8.5
8.5. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 5: Maternal haemoglobin level at delivery (in g/dL)
8.6
8.6. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 6: Low birth weight (< 2500 g)
8.7
8.7. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 7: Mean birth weight (in grams)
8.8
8.8. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 8: Cord blood parasitaemia
8.9
8.9. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 9: Prematurity
8.10
8.10. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 10: SAEs during pregnancy
8.11
8.11. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 11: Spontaneous abortion
8.12
8.12. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 12: Stillbirth
8.13
8.13. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 13: Congenital malformations
8.14
8.14. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 14: Maternal mortality
8.15
8.15. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 15: Early neonatal mortality (< 7 days)
8.16
8.16. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 16: Infant mortality (≥ 7 days up to 6 weeks of age)
8.17
8.17. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 17: Adverse events: headache
8.18
8.18. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 18: Adverse events: vomiting
8.19
8.19. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 19: Adverse events: dizziness
8.20
8.20. Analysis
Comparison 8: Mefloquine (MQ) versus daily cotrimoxazole (CTXp), Outcome 20: Adverse events: fatigue/weakness
9.1
9.1. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 1: Maternal peripheral parasitaemia at delivery (blood smear)
9.2
9.2. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 2: Maternal anaemia at delivery (packed cell volume <33%)
9.3
9.3. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 3: Maternal anaemia at delivery (< 120 g/L)
9.4
9.4. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 4: Placental malaria: acute infection (histology)
9.5
9.5. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 5: Placental malaria: chronic infection (histology)
9.6
9.6. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 6: Mean haemoglobin at delivery (in g/L)
9.7
9.7. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 7: Low birth weight (< 2500 g)
9.8
9.8. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 8: Mean birth weight (in grams)
9.9
9.9. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 9: Prematurity
9.10
9.10. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 10: Mother‐to‐child transmission of HIV
9.11
9.11. Analysis
Comparison 9: Sulfadoxine‐pyrimethamine (SP) versus placebo, Outcome 11: Maternal viral load at delivery (≥ 10 000 copies/mL)
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Akinyotu 2018 {published data only}
    1. Akinyotu O, Bello F, Abdus-Salam R, Arowojolu A. Comparative study of mefloquine and sulphadoxine-pyrimethamine for malaria prevention among pregnant women with HIV in southwest Nigeria. International Journal of Gynecology and Obstetrics 2018;142(2):194-200. [DOI: 10.1002/ijgo.12516] - DOI - PubMed
    1. NCT02524444. A comparative study of mefloquine and S-P as prophylaxis against malaria in pregnant HIV + patients. clinicaltrials.gov/study/NCT02524444 (first posted on 12 August 2015).
Akinyotu 2019 {published and unpublished data}
    1. Akinyotu O, Bello F, Abdus-Salam R, Arowojolu A. A randomized controlled trial of azithromycin and sulphadoxine-pyrimethamine as prophylaxis against malaria in pregnancy among human immunodeficiency virus-positive women. Transactions of the Royal Society of Tropical Medicine and Hygiene 2019;113(8):463-70. [DOI: 10.1093/trstmh/trz028] - DOI - PubMed
    1. NCT02527005. A comparative study of azithromycin and S-P as prophylaxis in pregnant HIV+ patients. clinicaltrials.gov/study/NCT02527005 (first posted on 17 August 2015).
Barsosio 2024 {published and unpublished data}
    1. Barsosio HC, Madanitsa M, Ondieki ED, Dodd J, Onyango ED, Otieno K, et al. Chemoprevention for malaria with monthly intermittent preventive treatment with dihydroartemisinin-piperaquine in pregnant women living with HIV on daily co-trimoxazole in Kenya and Malawi: a randomised, double-blind, placebo-controlled trial. Lancet 2024;403(10424):365-78. [DOI: 10.1016/S0140-6736(23)02631-4] - DOI - PMC - PubMed
Denoeud‐Ndam 2014a {published and unpublished data}
    1. Denoeud-Ndam L, Zannou DM, Fourcade C, Taron-Brocard C, Porcher R, Atadokpede F, et al. Cotrimoxazole prophylaxis versus mefloquine intermittent preventive treatment to prevent malaria in HIV-infected pregnant women: two randomized controlled trials. Journal of Acquired Immune Deficiency Syndromes 2014;65(2):198-206. [DOI: 10.1097/QAI.0000000000000058] - DOI - PubMed
    1. NCT00970879. Prevention of pregnancy-associated malaria in HIV-infected women: cotrimoxazole prophylaxis versus mefloquine (PACOME). clinicaltrials.gov/study/NCT00970879 (first posted 2 September 2009).
Denoeud‐Ndam 2014b {published and unpublished data}
    1. Denoeud-Ndam L, Zannou DM, Fourcade C, Taron-Brocard C, Porcher R, Atadokpede F, et al. Cotrimoxazole prophylaxis versus mefloquine intermittent preventive treatment to prevent malaria in HIV-infected pregnant women: two randomized controlled trials. Journal of Acquired Immune Deficiency Syndromes 2014;65(2):198-206. [DOI: 10.1097/QAI.0000000000000058] - DOI - PubMed
    1. NCT00970879. Prevention of pregnancy-associated malaria in HIV-infected women: cotrimoxazole prophylaxis versus mefloquine (PACOME). clinicaltrials.gov/study/NCT00970879 (first posted 2 September 2009).
Filler 2006 {published data only}
    1. Filler SJ, Kazembe P, Thigpen M, Macheso A, Parise ME, Newman RD, et al. Randomized trial of 2-dose versus monthly sulfadoxine-pyrimethamine intermittent preventive treatment for malaria in HIV-positive and HIV-negative pregnant women in Malawi. Journal of Infectious Diseases 2006;194(3):286-93. [DOI: 10.1086/505080] - DOI - PubMed
    1. NCT00126906. Prevention of malaria during pregnancy using intermittent preventive treatment with sulfadoxine-pyrimethamine: Malawi. clinicaltrials.gov/study/NCT00126906 (first posted 3 August 2005).
González 2014 {published and unpublished data}
    1. González R, Desai M, Macete E, Ouma P, Kakolwa MA, Abdulla S, et al. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-infected women receiving cotrimoxazole prophylaxis: a multicenter randomized placebo-controlled trial. PLOS Medicine 2014;11(9):e1001735. [DOI: 10.1371/journal.pmed.1001735] - DOI - PMC - PubMed
    1. NCT00811421. Evaluation of alternative antimalarial drugs for malaria in pregnancy (MiPPAD). clinicaltrials.gov/study/NCT00811421 (first posted 18 December 2008).
González 2024 {published data only}
    1. González R, Nhampossa T, Mombo-Ngoma G, Mischlinger J, Esen M, Tchouatieu AM, et al. Evaluation of the safety and efficacy of dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria in HIV-infected pregnant women: protocol of a multicentre, two-arm, randomised, placebo-controlled, superiority clinical trial (MAMAH project). BMJ Open 2021;11(11):e053197. [DOI: 10.1136/bmjopen-2021-053197] - DOI - PMC - PubMed
    1. González R, Nhampossa T, Mombo-Ngoma G, Mischlinger J, Esen M, Tchouatieu AM, et al. Safety and efficacy of dihydroartemisinin-piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial. Lancet Infectious Diseases 2024;24(5):476-87. [DOI: 10.1016/S1473-3099(23)00738-7] - DOI - PubMed
Hamer 2007 {published data only}
    1. Hamer DH, Mwanakasale V, Macleod WB, Chalwe V, Mukwamataba D, Champo D, et al. Two-dose versus monthly intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine in HIV-seropositive pregnant Zambian women. Journal of Infectious Diseases 2007;196(11):1585-94. [DOI: 10.1086/522142] - DOI - PubMed
    1. NCT00270530. Intermittent preventive treatment of malaria in HIV-seropositive pregnant women in Zambia. clinicaltrials.gov/study/NCT00270530 (first posted 23 December 2005).
Klement 2013 {published data only}ISRCTN98835811
    1. ISRCTN98835811. Cotrimoxazol to prevent malaria in HIV-infected pregnant women in sub-Saharan Africa. www.isrctn.com/ISRCTN98835811 (first posted 27 August 2012).
    1. Klement E, Pitché P, Kendjo E, Singo A, D'Almeida S, Akouete F, et al. Effectiveness of co-trimoxazole to prevent Plasmodium falciparum malaria in HIV-positive pregnant women in sub-Saharan Africa: an open-label, randomized controlled trial. Clinical Infectious Diseases 2014;58(5):651-9. [DOI: 10.1093/cid/cit806] - DOI - PubMed
Manirakiza 2021 {published data only}
    1. Manirakiza A, Tondeur L, Ketta MYB, Sepou A, Serdouma E, Gondje S, et al. Cotrimoxazole versus sulfadoxine–pyrimethamine for intermittent preventive treatment of malaria in HIV-infected pregnant women in Bangui, Central African Republic: a pragmatic randomised controlled trial. Tropical Medicine & International Health 2021;26(10):1314-23. [DOI: 10.1111/tmi.13668] - DOI - PubMed
    1. NCT01746199. Efficacy of antifolates against malaria in HIV-infected pregnant women and the emergence of induced resistance in Plasmodium falciparum (MACOMBA). clinicaltrials.gov/study/NCT01746199 (first posted 6 December 2012).
Manyando 2014 {published data only}
    1. Manyando C, Njunju EM, Mwakazanga D, Chongwe G, Mkandawire R, Champo D, et al. Safety of daily co-trimoxazole in pregnancy in an area of changing malaria epidemiology: a phase 3b randomized controlled clinical trial. PLOS One 2014;9(5):e96017. [DOI: 10.1371/journal.pone.0096017] - DOI - PMC - PubMed
    1. NCT00711906. Daily co-trimoxazole prophylaxis to prevent malaria in pregnancy. clinicaltrials.gov/study/NCT00711906 (first posted 8 July 2008).
Menéndez 2008 {published data only}
    1. Menéndez C, Bardají A, Sigauque B, Romagosa C, Sanz S, Serra-Casas E, et al. A randomized placebo-controlled trial of intermittent preventive treatment in pregnant women in the context of insecticide treated nets delivered through the antenatal clinic. PLOS One 2008;3(4):e1934. [DOI: 10.1371/journal.pone.0001934] - DOI - PMC - PubMed
    1. NCT00209781. IPTp plus ITNs for malaria control in pregnant women. clinicaltrials.gov/study/NCT00209781 (first posted 13 September 2005).
    1. Naniche D, Lahuerta M, Bardaji A, Sigauque B, Romagosa C, Berenguera A, et al. Mother-to-child transmission of HIV-1: association with malaria prevention, anaemia and placental malaria. HIV Medicine 2008;9(9):757-64. [DOI: 10.1111/j.1468-1293.2008.00626.x] - DOI - PubMed
Natureeba 2017 {published data only}
    1. NCT02282293. Reducing the burden of malaria in HIV-infected pregnant women and their HIV-exposed children (PROMOTE-BC2). clinicaltrials.gov/study/NCT02282293 (first posted 3 November 2014).
    1. Natureeba P, Kakuru A, Muhindo M, Ochieng T, Ategeka J, Koss CA, et al. Intermittent preventive treatment with dihydroartemisinin-piperaquine for the prevention of malaria among HIV-infected pregnant women. Journal of Infectious Diseases 2017;216(1):29-35. [DOI: 10.1093/infdis/jix110] - DOI - PMC - PubMed

References to studies excluded from this review

Gill 2007 {published data only}
    1. Gill CJ, Macleod WB, Mwanakasale V, Chalwe V, Mwananyanda L, Champo D, et al. Inferiority of single-dose sulfadoxine-pyrimethamine intermittent preventive therapy for malaria during pregnancy among HIV-positive Zambian women. Journal of Infectious Diseases 2007;196(11):1577-84. [DOI: 10.1086/522137] - DOI - PubMed
Luntamo 2010 {published data only (unpublished sought but not used)}
    1. Luntamo M, Kulmala T, Mbewe B, Cheung YB, Maleta K, Ashorn P. Effect of repeated treatment of pregnant women with sulfadoxine-pyrimethamine and azithromycin on preterm delivery in Malawi: a randomized controlled trial. American Journal of Tropical Medicine and Hygiene 2010;83(6):1212-20. [DOI: 10.4269/ajtmh.2010.10-0264] - DOI - PMC - PubMed
    1. Luntamo M, Rantala AM, Meshnick SR, Cheung YB, Kulmala T, Maleta K, et al. The effect of monthly sulfadoxine-pyrimethamine, alone or with azithromycin, on PCR-diagnosed malaria at delivery: a randomized controlled trial. PLOS One 2012;7(7):e41123. [DOI: 10.1371/journal.pone.0041123] - DOI - PMC - PubMed
    1. NCT00131235. Gestational sulfadoxine-pyrimethamine and azithromycin treatment to prevent preterm birth. clinicaltrials.gov/study/NCT00131235 (first posted 16 August 2005).
Parise 1998 {published data only}
    1. Parise ME, Ayisi JG, Nahlen BL, Schultz LJ, Roberts JM, Misore A, et al. Efficacy of sulfadoxine-pyrimethamine for prevention of placental malaria in an area of Kenya with a high prevalence of malaria and human immunodeficiency virus infection. American Journal of Tropical Medicine and Hygiene 1998;59(5):813-22. [DOI: 10.4269/ajtmh.1998.59.813] - DOI - PubMed

References to ongoing studies

NCT00132535 {published data only}
    1. NCT00132535. Influence of chloroquine on HIV viral load among pregnant women in Uganda. clinicaltrials.gov/study/NCT00132535?tab=history (first posted 19 August 2005).
NCT00164255 {published data only}
    1. NCT00164255. Efficacy of combination therapy for prevention of effects of malaria during pregnancy. clinicaltrials.gov/study/NCT00164255 (first posted 9 September 2005).
NCT03431168 (PREMISE) {published data only}
    1. NCT03431168. A novel regimen to prevent malaria and STI in pregnant women with HIV (PREMISE) [The PREMISE trial: a novel regimen to prevent malaria and sexually transmitted infections in pregnant women with HIV]. clinicaltrials.gov/study/NCT03431168 (first posted 13 February 2018).
PACTR201612001901313 {published data only}PACTR201612001901313
    1. PACTR201612001901313. Effectiveness of the combination of dihydroartemisinin and piperaquine for prevention of falciparum malaria during pregnancy in Tanzania. pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1901 (first posted 2 December 2016).

Additional references

CDC 2019
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Denoeud‐Ndam 2013
    1. Denoeud-Ndam L, Fourcade C, Ogouyemi-Hounto A, Azon-Kouanou A, d'Almeida M, Azondékon A, et al. Predictive factors of plasma HIV suppression during pregnancy: a prospective cohort study in Benin. PLOS One 2013;8(3):e59446. [DOI: 10.1371/journal.pone.0059446] - DOI - PMC - PubMed
Desai 2007
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Desai 2015
    1. Desai M, Gutman J, L'lanziva A, Otieno K, Juma E, Kariuki S, et al. Intermittent screening and treatment or intermittent preventive treatment with dihydroartemisinin-piperaquine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for the control of malaria during pregnancy in western Kenya: an open-label, three-group, randomised controlled superiority trial. Lancet 2015;386(10012):2507-19. - PMC - PubMed
Eisele 2012
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Figueroa‐Romero 2024
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Gamble 2007
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González 2014
    1. González R, Desai M, Macete E, Ouma P, Kakolwa MA, Abdulla S, et al. Intermittent preventive treatment of malaria in pregnancy with mefloquine in HIV-infected women receiving cotrimoxazole prophylaxis: a multicenter randomized placebo-controlled trial. PLOS Medicine 2014;11(9):e1001735. - PMC - PubMed
González 2016
    1. González R, Sevene E, Jagoe G, Slutsker L, Menéndez C. A public health paradox: the women most vulnerable to malaria are the least protected. PLOS Medicine 2016;13(5):e1002014. - PMC - PubMed
González 2018
    1. González R, Pons-Duran C, Piqueras M, Aponte JJ, Ter Kuile FO, Menéndez C. Mefloquine for preventing malaria in pregnant women. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No: CD011444. [DOI: 10.1002/14651858.CD011444.pub3] - DOI - PMC - PubMed
González 2012
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Gutman 2017
    1. Gutman J, Kovacs S, Dorsey G, Stergachis A, Ter Kuile FO. Safety, tolerability, and efficacy of repeated doses of dihydroartemisinin-piperaquine for prevention and treatment of malaria: a systematic review and meta-analysis. Lancet Infectious Diseases 2017;17(2):184-93. - PMC - PubMed
Higgins 2011
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Kakuru 2016
    1. Kakuru A, Jagannathan P, Muhindo MK, Natureeba P, Awori P, Nakalembe M, et al. Dihydroartemisinin-piperaquine for the prevention of malaria in pregnancy. New England Journal of Medicine 2016;374(10):928-39. - PMC - PubMed
Kamya 2012
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Mayor 2015
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McKenzie 2023
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Menéndez 2010
    1. Menéndez C, Bardají­ A, Sigauque B, Sanz S, Aponte JJ, Mabunda S, et al. Malaria prevention with IPTp during pregnancy reduces neonatal mortality. PLOS One 2010;5(2):e9438. - PMC - PubMed
Menéndez 2011
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