CTX alone provided adequate protection against malaria in HIV-infected pregnant women, although MQ-IPTp showed higher efficacy against placental infection. Although more frequently associated with dizziness and vomiting, MQ-IPTp may be an effective alternative given concerns about parasite resistance to CTX.

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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.

Recurrent genital herpes in immunocompromised patients may sometimes run a severe course spreading all over the perineum. Herpes simplex virus may develop resistance to acyclovir. A recurrent genital herpes simplex virus (HSV) infection complicating the treatment of Hodgkin's disease continued to spread in spite of acyclovir treatment via discontinuous infusion. Resolution of genital herpes was obtained with continuous infusion of acyclovir. Case ReportA 32-year-old woman had a history of recurrent genital herpes and received long-term treatment with oral acyclovir. Because of Hodgki.n's disease, chemotherapy and radiotherapy had been performed. A very low white blood cell and lymphocyte count was observed and the patient was consequently put on G-CSF (granuloeyte colony-stimulating factor). A disseminated eryptococcosis (fungemia, meningo-encephalitis, pneumonia) occurred and was treated with amphotericin B + 5 fluorocytosine, both intravenously, followed by fluconazole. Recurrent genital herpes appeared during the hospital stay, extending to a large placard over the perineum. The patient was then put on acyclovir IV 500 mg 1 h q.8 (i.e., 45 mg/kg/day). There was no improvement after 12 days of treatment. Therefore a continuous infusion of acyclovir was performed (2 g/day, 50 mg/kg/day) leading to recovery. The dosage of acyclovir was diluted to a total of 240 ml to be administered intravenously by a constant rate infusion.pump. The patient responded clinically within 6 days and by 14 days her lesions had healed, Unfortunately, we could neither carry out swabs from suspected lesions to isolate HSV, nor could we measure acyclovir levels in plasma.

BackgroundMalaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa. Foetal and neonatal outcomes of this co-infection have been extensively studied. However, little is known about maternal morbidity due to clinical malaria in pregnancy, especially malaria-related fever, in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies.MethodsA cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever, as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women. Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery, with at least three scheduled visits during pregnancy. Confirmed malaria-related fever was defined as axillary temperature >37.5°C and a concomitant, positive, thick blood smear or rapid diagnostic test for Plasmodium falciparum. Suspected malaria-related fever was defined as an axillary temperature >37.5°C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation.ResultsIncidence rate for confirmed malaria-related fever was of 127.9 per 1,000 person-year (PY) (95% confidence interval (CI): 77.4-211.2). In multivariate analysis, CD4 lymphocytes (Relative Risk (RR) for a 50 cells/mm3 variation = 0.82; CI: 0.71-0.96), antiretroviral treatment started before inclusion (RR = 0.34; CI: 0.12-0.98) and history of symptomatic malaria in early pregnancy (RR = 7.10; CI: 2.35-22.49) were associated with the incidence of confirmed or suspected malaria-related fever. More than a half of participants with parasitaemia were symptomatic, with fever being the most common symptom. The crude fraction of febrile episodes attributable to malaria was estimated at 91%.ConclusionsThis work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women, with cellular immunodepression as a major determinant, and establishes the possible advantage offered by the early initiation of antiretroviral treatment.Trial registrationPACOME Study has been registered under the number NCT00970879.