Eficácia da dihidroartemisinina-piperaquina em associação com sulfametoxazol-trimetoprima na prevenção da malária em gestantes HIV-positivas: revisão sistemática e metanálise.

Abstract

The World Health Organization (WHO) recommends the use of sulfamethoxazole-trimethoprim as intermittent prophylaxis for HIV-positive pregnant women; however, its efficacy remains uncertain, necessitating the exploration of viable alternatives. The initial search consisted of a systematic review conducted in the PubMed, Embase, and Cochrane Library databases, which identified a set of relevant studies, of which three randomized clinical trials, involving a total of 1,770 HIV-positive pregnant women, met the inclusion criteria. The aim was to compare the monthly use of dihydroartemisinin-piperaquine combined with daily sulfamethoxazole-trimethoprim versus the use of sulfamethoxazole-trimethoprim alone. The intervention group exhibited a significant reduction in the incidence of clinical malaria during pregnancy (RR 0.27; 95% CI 0.09-0.75; p=0.01; I²=0%) as well as in the risk of malaria infection diagnosed by any method (RR 0.46; 95% CI 0.33-0.64; p<0.01; I²=0%). However, no significant changes were observed in the rate of placental infection detected by histology (RR 0.47; 95% CI 0.23-0.96; p=0.04; I²=0%) or in adverse gestational or neonatal outcomes. Thus, the combination of dihydroartemisinin-piperaquine with sulfamethoxazole-trimethoprim proved effective in reducing the cases of clinical malaria and the risk of malaria infection diagnosed by any method, yet it did not demonstrate advantages regarding adverse gestational and neonatal outcomes.