Intermittent Preventive Treatment Regimens for Malaria in HIV-Positive Pregnant Women: Systematic Review and Meta-Analysis of Clinical Trials.

Abstract

Background: The WHO recommended the use of intermittent preventive treatment (IPT) regimens for malaria in HIV-positive pregnant women living in endemic areas to prevent malaria-related perinatal complications. However, the high drug resistance rates make the effectiveness of the various available options questionable.

Methods: This systematic review and meta-analysis was conducted according to the PRISMA guidelines and registered in Prospero (ID: CRD42024579942). PubMed, Scopus, and Cochrane libraries were searched in June 2024 for relevant studies. Randomized clinical trials reporting the use of ITP for malaria in HIV-infected pregnant women were included. The incidence of peripheral malaria diagnosis was our primary extracted outcome. RevMan 5.3 was used for meta-analysis.

Results: Thirteen clinical trials with 5226 HIV-positive pregnant patients were included. ITP showed 55% lower odds of malaria during pregnancy or at delivery (OR = 0.45, 95% CI: 0.36, 0.56, P ≤ 0.001), with IPTp-DP (Dihydroartemisinin-Piperaquine) being the most effective regimen. However, despite reducing the odds of placental malaria by 48% (OR = 0.52, 95% CI: 0.39, 0.70, P ≤ 0.001), ITP showed no significant effect on low birth weight, fetal loss, stillbirth, or preterm labor. Furthermore, IPT reduces the odds of maternal anemia by 18% (OR = 0.82, 95% CI: 0.69, 0.97, P = 0.03).

Conclusion: IPT was shown to be effective in reducing malaria-related maternal complications, including malaria during pregnancy, at delivery, or placental and maternal anemia. However, it showed no effective impact on adverse birth outcomes. Further research may be necessary to explore birth-related outcomes.