Dihydroartemisinin-piperaquine for Malaria Prevention in HIV‐Positive Pregnant Women: Systematic Review and Meta-Analysis of Clinical Trials

Authors

Keywords:

Malaria, HIV, pregnancy

Abstract

BACKGROUND: Dihydroartemisinin-piperaquine (DP) is a long-acting artemisinin combination treatment that provides effective chemoprevention and has been proposed as an alternative antimalarial drug for intermittent preventive therapy in pregnancy (IPTp). Prevention of malaria infection during pregnancy in HIV-negative women currently relies on the use of long-lasting insecticidal nets together with intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). Increasing sulfadoxine-pyrimethamine resistance in Africa threatens the current prevention of malaria during pregnancy. Thus, a replacement for IPTp-SP is urgently needed, especially for locations with high sulfadoxine–pyrimethamine resistance. Dihydroartemisinin-piperaquine is a promising candidate. This systematic review aimed to assess the effectiveness and safety of IPTp-DP in HIV-positive pregnant women.

METHODS: This systematic review and meta-analysis followed Cochrane guidelines. Our inclusion criteria were clinical trials on HIV-positive pregnant women using dihydroartemisinin-piperaquine regimens compared to any control group. Primary outcomes included maternal, placental, and cord malaria incidence; secondary outcomes included maternal and neonatal health and adverse effects. We searched PubMed, the Cochrane Library, and Scopus for relevant articles. Two independent reviewers screened the articles. A third reviewer resolved the discrepancies. Meta-analysis was done using RevMan 5.3. Fixed- or random-effects models were used based on heterogeneity, with odds ratios comparing intervention and control groups.

RESULTS: Intermittent preventive treatment with dihydroartemisinin-piperaquine (IPT-DP) during pregnancy significantly reduces the risk of malaria-related outcomes. Specifically, IPT was associated with a 55% decrease in the odds of having malaria during pregnancy (OR = 0.45, 95% CI: 0.36, 11.18, P ≤ 0.001); a 39% decrease in the odds of placental malaria (OR = 0.61, 95% CI: 0.43, 0.85, P = 0.004); and a 46% decrease in the odds of malaria at delivery (OR = 0.54, 95% CI: 0.30, 0.98, P = 0.04) (Figure 1). However, there was no significant reduction in the risk of adverse events (OR = 0.94, 95% CI: 0.73, 1.20, P = 0.61); low birth weight (OR = 0.94, 95% CI: 0.73, 1.20, P = 0.61); foetal loss (OR = 1.14, 95% CI: 0.67, 1.94, P = 0.62); or stillbirth (OR = 1.03, 95% CI: 0.56, 1.89, P = 0.93). On the other hand, there was a statistically significant increase in the risk of miscarriage in the IPT group compared to the control (OR = 3.37, 95% CI: 1.08, 10.51, P ≤ 0.001). This is 3.37 times the odds of miscarriage with IPT use.

CONCLUSION: Dihydroartemisinin-piperaquine reduces the risk of malaria and placental malaria in HIV pregnant women. Also, it does not significantly impact adverse pregnancy outcomes such as low birth weight, foetal loss, or stillbirth. However, DP increases the risk of miscarriage. This indicates the need for careful prescriptions for HIV pregnant women.

Metrics

Metrics Loading ...

References

Ter Kuile FT, Parise M, Verhoeff F, Udhayakumar V, Newman R, Van Eijk AV, et al. The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa. 2004. https://www.semanticscholar.org/paper/The-burden-of-co-infection-with-human-virus-type-1-Kuile-Parise/576ba229f686abc3d1eddaacfbb76972b10471e9.

Bulterys PL, Kaplan JE, Gutman J. Editorial Commentary: Preventing Malaria in HIV-Infected Pregnant Women. Clinical Infectious Diseases 2013;58:660–2. https://doi.org/10.1093/cid/cit805.

Figueroa-Romero A, Pons-Duran C, Gonzalez R. Drugs for Intermittent Preventive Treatment of Malaria in Pregnancy: Current Knowledge and Way Forward. Tropical Medicine and Infectious Disease 2022;7:152. https://doi.org/10.3390/tropicalmed7080152.

Moore BR, Davis TME. Pharmacotherapy for the prevention of malaria in pregnant women: currently available drugs and challenges. Expert Opinion on Pharmacotherapy 2018;19:1779–96. https://doi.org/10.1080/14656566.2018.1526923 .

Downloads

Published

2025-01-01

How to Cite

Tarig, A., Noorallah, T., Abdelazim, E., Altraifi, S., Altraifi, H., Elhaj, A., & Elnaiem , W. (2025). Dihydroartemisinin-piperaquine for Malaria Prevention in HIV‐Positive Pregnant Women: Systematic Review and Meta-Analysis of Clinical Trials. International Journal of Medical Students, 12, S360. Retrieved from https://ijms.pitt.edu/IJMS/article/view/2946

Issue

Vol 12. (2024): Supplement 1

Section

Abstracts of the WCMSR

Categories

License

Copyright (c) 2024 Ammar Tarig, Tibyan Noorallah, Egbal Abdelazim, Sara Altraifi, Hajir Altraifi, Ammar Elhaj, Walaa Elnaiem

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

  1. The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
  2. Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
  3. The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
    1. Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
    2. The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
    3. Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
    4. Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
    5. The Author represents and warrants that:
      1. the Work is the Author’s original work;
      2. the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
      3. the Work is not pending review or under consideration by another publisher;
      4. the Work has not previously been published;
      5. the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
      6. the Work contains no libel, invasion of privacy, or other unlawful matter.
    6. The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.

Enforcement of copyright

The IJMS takes the protection of copyright very seriously.

If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.

If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org

 

Infringing material

If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org