Marked reduction in prevalence of malaria parasitemia and anemia in HIV-infected pregnant women taking cotrimoxazole with or without sulfadoxine-pyrimethamine intermittent preventive therapy during pregnancy in Malawi

J Infect Dis. 2011 Feb 15;203(4):464-72. doi: 10.1093/infdis/jiq072. Epub 2011 Jan 7.


Background: Effectiveness of cotrimoxazole (CTX) compared with sulfadoxine-pyrimethamine (SP) intermittent-preventive-therapy (IPTp) for malaria in HIV-infected pregnant women is unknown. We examined effectiveness of CTX with or without SP-IPTp versus SP-IPTp at reducing malaria parasitemia and anemia.

Methods: From 2005 to 2009, we conducted a cross-sectional study of HIV-infected pregnant women at Thyolo Hospital, Malawi. Blood was tested for malaria parasitemia and anemia (hemoglobin<11 g/dl). Data were collected on use of anti-malaria interventions and other risk factors. CTX prophylaxis policy for HIV-infected pregnant women was introduced in 2007, but implementation problems resulted in some women receiving both CTX and SP-IPTp.

Findings: We enrolled 1,142 women, of whom 1,121 had data on CTX and/or SP-IPTp intake. Of these, 49.7%, 29.8%, and 15.4% reported taking SP-IPTp only, CTX only and SP-IPTp plus CTX, respectively. Compared with women taking SP-IPTp, those taking SP-IPTp plus CTX and CTX were less likely to have malaria parasitemia (OR, [95%CI]: 0.09, [0.01-0.66] and 0.43, [0.19-0.97], respectively) or anemia (PR, [95% CI]: 0.67, [0.54-0.83] and 0.72, [0.61-0.83], respectively).

Conclusion: In HIV-infected pregnant women, daily CTX was associated with reduced malaria parasitemia and anemia compared with SP-IPTp. CTX plus SP-IPTp was associated with further reduction in malaria parasitemia but toxicity was not fully assessed.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Anemia / epidemiology*
  • Anemia / prevention & control
  • Antimalarials / therapeutic use
  • Chemoprevention / methods
  • Cross-Sectional Studies
  • Drug Combinations
  • Female
  • HIV Infections / complications*
  • Humans
  • Malaria / complications
  • Malaria / epidemiology*
  • Malaria / parasitology
  • Malaria / prevention & control
  • Malawi / epidemiology
  • Middle Aged
  • Parasitemia / epidemiology*
  • Parasitemia / prevention & control
  • Pregnancy
  • Pregnancy Complications, Infectious / epidemiology*
  • Prevalence
  • Pyrimethamine / therapeutic use*
  • Sulfadoxine / therapeutic use*
  • Treatment Outcome
  • Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use*
  • Young Adult


  • Antimalarials
  • Drug Combinations
  • fanasil, pyrimethamine drug combination
  • Trimethoprim, Sulfamethoxazole Drug Combination
  • Sulfadoxine
  • Pyrimethamine