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  • Azithromycin Addition...

Azithromycin Addition to TMP-SMX Fails to Reduce Malaria and STI Risk in Pregnant Women with HIV: Study

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2024-05-29T20:45:22+05:30  |  Updated On 30 May 2024 12:12 PM IST
Azithromycin Addition to TMP-SMX Fails to Reduce Malaria and STI Risk in Pregnant Women with HIV: Study
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Researchers have found that adding azithromycin (AZ) to the standard daily trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis does not reduce the risk of malaria or bacterial sexually transmitted infections (STIs) at delivery among pregnant women with HIV in Cameroon. This study, conducted between March 2018 and August 2020, aimed to test a novel regimen to prevent these infections, but the results suggest no significant benefit from the addition of azithromycin. This study was published in the journal Open Forum Infectious Diseases by Dionne and colleagues.

Malaria and sexually transmitted infections pose significant health risks to pregnant women, particularly those living with HIV. The standard prophylactic regimen involves daily TMP-SMX, which has shown efficacy in reducing certain infections. This study hypothesized that the addition of azithromycin, known for its broad-spectrum antibiotic properties, would further reduce the rates of malaria and bacterial STIs at delivery.

This randomized, controlled trial enrolled 308 pregnant women with HIV, all under 28 weeks of gestation. Participants were randomized into two groups: 155 women received TMP-SMX with monthly azithromycin (1 gram daily for three days), and 153 women received TMP-SMX with a placebo. The primary outcomes were the presence of peripheral malaria infection (detected by microscopy or PCR) and a composite measure of bacterial genital STIs (including C. trachomatis, N. gonorrhoeae, and syphilis) at delivery. Statistical analysis involved estimating relative risks (RR) and 95% confidence intervals (CI) using 2 × 2 tables, with significance set at p < 0.05.

Results:

• A total of 308 women were enrolled, with a loss to follow-up rate of 3.2%. The baseline characteristics of the groups were similar.

• At delivery, 16.3% of women in the TMP-SMX-AZ group had malaria, compared to 13.2% in the TMP-SMX group (RR 1.24, 95% CI 0.71-2.16, p=0.12).

• The incidence of bacterial STIs was 4.2% in the TMP-SMX-AZ group versus 5.8% in the TMP-SMX group (RR 0.72, 95% CI 0.26-2.03, p=0.28).

• There were no significant differences in adverse birth outcomes. Preterm delivery occurred in 6.7% of the TMP-SMX-AZ group and 10.7% of the TMP-SMX group (p=0.3).

• Low birth weight was observed in 3.4% of the TMP-SMX-AZ group and 5.4% of the TMP-SMX group (p=0.6)

The study's findings indicate that the addition of azithromycin to the standard TMP-SMX regimen does not provide additional protection against malaria or bacterial STIs at delivery for pregnant women with HIV. These results align with previous research that has shown mixed outcomes for azithromycin in similar contexts.

The trial concluded that adding monthly azithromycin to daily TMP-SMX prophylaxis does not significantly reduce the risk of malaria or bacterial STIs at delivery in pregnant women with HIV in Cameroon. Future research should explore alternative strategies to enhance infection prevention in this high-risk population.

Reference:

Dionne, J. A., Anchang-Kimbi, J., Hao, J., Long, D., Apinjoh, T., Tih, P., Mbah, R., Ngah, E. N., Juliano, J. J., Kahn, M., Bruxvoort, K., Van Der Pol, B., Tita, A. T. N., Marrazzo, J., & Achidi, E. (2024). Trimethoprim-sulfamethoxazole plus azithromycin to prevent malaria and sexually transmitted infections in pregnant women with HIV (PREMISE): A randomized, double-masked, placebo-controlled, phase IIB clinical trial. Open Forum Infectious Diseases. https://doi.org/10.1093/ofid/ofae274

Open Forum Infectious DiseasesHIVpregnancymalariasexually transmitted infectionsazithromycintrimethoprim-sulfamethoxazoleprophylaxis
Source : Open Forum Infectious Diseases
Dr Riya Dave
Dr Riya Dave

    Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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