A Phase 3 interventional study of cotrimoxazole and mefloquine in Malaria in Pregnancy and HIV Infections, sponsored by Institut de Recherche pour le Developpement. Completed at 5 sites in Benin. Open to female participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2013-01-23.
Sponsored by Institut de Recherche pour le Developpement · Phase 3, Interventional, and Prevention
The purpose of this study is to evaluate the efficacy of cotrimoxazole prophylaxis in prevention of malaria during pregnancy in HIV-infected women, compared to intermittent preventive treatment with mefloquine.
Malaria infection during pregnancy can have adverse effects on both mother and fetus, including maternal anaemia and low birth weight which are responsible for mother and infant mortality. It is a particular problem for women in their first and second pregnancies and for women who are HIV-positive. Maternal HIV infection potentiates many of these adverse effects. In HIV-infected women, the World Health Organization (WHO) advocates the use of insecticide-treated bednets, and drugs : If the CD4 cell count is below 350/mm3 or the HIV disease is in WHO stage 2, 3 or 4, cotrimoxazole prophylaxis for the prevention of pneumocystosis and toxoplasmosis is indicated, that is assumed to also protect those women from malaria. Otherwise, they have to receive at least three doses of intermittent preventive treatment (IPT), most commonly with sulfadoxine-pyrimethamine (SP) given at the antenatal care visits. If IPT with SP has been a subject of many investigations, cotrimoxazole efficacy has never been assessed in prevention of malaria during pregnancy.
The investigators aim to evaluate the efficacy of cotrimoxazole prophylaxis in prevention of malaria during pregnancy in HIV-infected women. The investigators postulate that cotrimoxazole prophylaxis is not inferior to IPT in all women, unrelated to their CD4 cell count. In the control arm, the investigators will use mefloquine as IPT. The safety and efficacy of this drug have already been assessed in HIV-negative patients (NCT00274235).
A randomized controlled trial will be conducted in five hospitals in Benin. Pregnant women will be enrolled both in the Antenatal Care unit and in the Infectious Diseases unit of each setting. All women will receive insecticide-treated bednets at enrolment. Randomization will be stratified by hospital and CD4 cell count range. Women assigned to cotrimoxazole will receive cotrimoxazole prophylaxis daily during all the course of pregnancy. Women assigned to mefloquine IPT will receive mefloquine three times during pregnancy. Women randomised in this arm and having a low CD4 cell count or an advanced HIV disease will also receive cotrimoxazole prophylaxis in prevention of HIV/AIDS opportunistic infections. Drug efficacy will be judged on the prevalence of placental malaria at delivery.
This study will contribute to updating the recommendations concerning the prevention of malaria during pregnancy in HIV-infected women.
Exclusion Criteria:
CD4 cell count≥350/mm3
Drug: cotrimoxazole
CD4 cell count≥350/mm3
Drug: mefloquine
CD4 cell count\<350/mm3
Drug: cotrimoxazole
CD4 cell count\<350/mm3
Drug: cotrimoxazole · Drug: mefloquine
800 mg sulfamethoxazole and 160 mg trimethoprim daily, from 28 weeks of gestation until delivery
mefloquine 15 mg/Kg three times, between 16 and 28 weeks, 24 and 32 weeks, then 28 and 36 weeks of pregnancy
proportion of placental malaria (presence of parasites in the placental blood smear at delivery)
Time frame: delivery
placental malaria mean parasite density at delivery
Time frame: delivery
proportion of low birth weight infants (<2500 g) and mean birth weight
Time frame: delivery
proportion of maternal anaemia (<11g/dl) and severe maternal anaemia (<8g/dl) at delivery and during pregnancy
Time frame: course of pregnancy and delivery
cord blood malaria infection at delivery (infant parasitemia)
Time frame: delivery
pre-term deliveries (< 37 weeks)
Time frame: delivery
spontaneous abortions (early:<28 weeks, late: ≥28 weeks) and still births
Time frame: course of pregnancy
congenital anomalies
Time frame: first 6 months of life
safety profile of the two treatments: proportion and detailed description of adverse effects in each treatment arm
Time frame: course of pregnancy (mother) anf first 6 months of life (infant)
Mother-to-child HIV transmission rate in each treatment arm
Time frame: 2 months after breastfeeding cessation
To document the effect of cotrimoxazole in reducing infections in HIV-infected women, we will measure the incidence of bacterial and parasitic infections (other than malaria) during pregnancy
Time frame: course of pregnancy
This study is completed, as verified in Jan 2013. You cannot join it, but the record below documents what was studied.
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Institut de Recherche pour le Developpement