Co-infection with malaria parasite and HIV is an emerging public health problem in tropical areas, particularly in pregnant women, and management of the concurrent effects of these two infections is challenging. Co-trimoxazole is a sulfamide preparation used to prevent opportunistic infections in HIV-infected patients, and many studies have reported that it has significant activity against malaria. As the efficacy of intermittent preventive treatment (IPT) with sulfadoxine-pyrimethamine (SP) against malaria is decreasing, co-trimoxazole might be an alternative for preventing malaria among HIV-infected populations. The aim of this study is to compare the effectiveness of SP-IPT, which is recommended for the prevention of malaria during pregnancy in the Central African Republic, with that of a daily dose of co-trimoxazole against P. falciparum infections among HIV-infected pregnant women in Bangui, the capital of the Central African Republic. The MACOMBA study (MAternity and COntrol of Malaria-HIV co-infection in BAngui) is a multicentre open-label randomized clinical trial conducted at four maternity hospitals in Bangui. All HIV-infected pregnant women presenting for an antenatal clinic visit between the weeks 16 and 28 of amenorrhoea, with a CD4 count of more than 350 cells/mm3, will be eligible. All the women will provide written consent before being enrolled in the study and will then be randomly allocated to either SP-IPT (25 mg of sulfadoxine and 1.25 mg of pyrimethamine) or daily co-trimoxazole doses (960 mg per dose). The primary end-point is the placental malaria parasitaemia rate at delivery. Other main outcome measures include the number of malaria episodes during pregnancy, safety, and treatment compliance. Furthermore, the frequency of molecular resistance markers dhfr and dhps will be measured. In this trial, we seek to confirm whether co-trimoxazole is operationally suitable to replace SP-IPT in order to prevent malaria among pregnant women infected with HIV in the Central African Republic. ClinicalTrials.gov Identifier: NCT01746199 .
Abstract Objective To identify current risk factors for hepatitis C virus ( HCV ) acquisition among E gyptians. Methods Patients with acute HCV were identified through a surveillance system of acute hepatitis in four fever hospitals in E gypt between 2002 and 2012. Case–control analysis was conducted, cases being incident acute symptomatic HCV and controls being acute hepatitis A identified at the same hospitals. The questionnaire covered iatrogenic, community and household exposures to HCV in the 1–6 months prior to onset of symptoms. Multivariate models were built to identify risk factors associated with HCV acquisition among non‐drug users and drug users separately. Results Among non‐drug users, hospital admission was independently associated with acute HCV infection ( OR = 4.2, 95% CI = 1.7–10.5). Several iatrogenic procedures, for example admission in a surgery unit, sutures, IV injections and IV infusions, highly correlated with hospital admission, were also associated with acute HCV infection and could have been used in the final model instead of hospital admission. Among drug users, identified risk factors were multiple sexual relations ( OR = 4.0, 95% CI = 1.1–14.7), intravenous drug use ( OR = 3.9, 95% CI = 1.2–13.0) and shaving at the barbershops ( OR = 8.7, 95% CI = 2.4–31.4). Illiteracy and marriage were significant risk factors in both groups. Conclusion Invasive medical procedures are still a major risk for acquiring new HCV infections in E gypt, as is illicit drug use in spreading HCV infection.
