Tolerability of Mefloquine Intermittent Preventive Treatment for Malaria in HIV-Infected Pregnant Women in Benin

Jun 19, 2012Journal of acquired immune deficiency syndromes (1999)

How well intermittent mefloquine treatment for malaria is tolerated by pregnant women with HIV in Benin

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Abstract

Adverse reactions were reported by 65% of HIV-infected women compared to 78% of HIV-negative women.

Dizziness and vomiting were identified as the most common adverse reactions.
HIV infection is associated with a decreased risk of adverse reactions (odds ratio = 0.23).
A detectable viral load, first intake of the medication, older age, and higher education levels are associated with increased risk of adverse reactions.
Moderate and severe adverse reactions were more frequent when antiretroviral therapy was started simultaneously with mefloquine intake.
Adverse reactions, although frequent, did not impair adherence to mefloquine intermittent preventive treatment.

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OBJECTIVE: To investigate the tolerability of mefloquine intermittent preventive treatment (MQ IPTp) for malaria in HIV-infected pregnant women compared with HIV-negative women.

DESIGN: Prospective cohort study comparing samples of HIV-negative and HIV-infected pregnant women from 2 clinical trials conducted in Benin.

METHODS: One hundred and three HIV-infected women from the ongoing PACOME trial were compared with 421 HIV-negative women from a former trial, both trials aiming to evaluate the efficacy and tolerability of MQ IPTp, administered at the dose of 15 mg/kg. Descriptive analysis compared the proportion of women reporting at least 1 adverse reaction, according to HIV status. Multilevel logistic regression identified factors associated with the probability of reporting an adverse reaction for each MQ intake.

RESULTS: Dizziness and vomiting were the most frequent adverse reactions. Adverse reactions were less frequent in HIV-infected women (65% versus 78%, P = 0.009). In multilevel analysis, HIV infection [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.08 to 0.61] decreased the risk for adverse reactions, whereas detectable viral load (OR = 2.46, 95% CI = 1.07 to 5.66), first intake (versus further intakes, OR = 5.26, 95% CI = 3.70 to 7.14), older age (OR = 1.62, 95% CI = 1.13 to 2.32), and higher education level (OR = 1.71, 95% CI = 1.12 to 2.61) increased the risk. Moderate and severe adverse reactions were more frequent when antiretrovirals were started concomitantly with a MQ intake.

CONCLUSIONS: This study provides reassuring data on the use of MQ IPTp in HIV-infected pregnant women. However frequent, adverse reactions remained moderate and did not impair adherence to MQ IPTp. In this high-risk group, MQ might be an acceptable alternative in case sulfadoxine-pyrimethamine loses its efficacy for intermittent preventive treatment.

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Tolerability of Mefloquine Intermittent Preventive Treatment for Malaria in HIV-Infected Pregnant Women in Benin

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