PubMed Health⌕ Search

Biomedical subjects

Albert Kilian

Publications and source records attributed to Albert Kilian.

4 recordsLinked to original sources
PubMed2005

Artemisinin versus nonartemisinin combination therapy for uncomplicated malaria: randomized clinical trials from four sites in Uganda.

BACKGROUND: Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination antimalarial therapy including artemisinins has been advocated recently to improve efficacy and limit the spread of resistance, but artemisinins are expensive and relatively untested in highly endemic areas. We compared artemisinin-based and other combination therapies in four districts in Uganda with varying transmission intensity. METHODS AND FINDINGS: We enrolled 2,160 patients aged 6 mo or greater with uncomplicated falciparum malaria. Patients were randomized to receive chloroquine (CQ) + sulfadoxine-pyrimethamine (SP); amodiaquine (AQ) + SP; or AQ + artesunate (AS). Primary endpoints were the 28-d risks of parasitological failure either unadjusted or adjusted by genotyping to distinguish recrudescence from new infections. A total of 2,081 patients completed follow-up, of which 1,749 (84%) were under the age of 5 y. The risk of recrudescence after treatment with CQ + SP was high, ranging from 22% to 46% at the four sites. This risk was significantly lower (p < 0.01) after AQ + SP or AQ + AS (7%-18% and 4%-12%, respectively). Compared to AQ + SP, AQ + AS was associated with a lower risk of recrudescence but a higher risk of new infection. The overall risk of repeat therapy due to any recurrent infection (recrudescence or new infection) was similar at two sites and significantly higher for AQ + AS at the two highest transmission sites (risk differences = 15% and 16%, p < 0.003). CONCLUSION: AQ + AS was the most efficacious regimen for preventing recrudescence, but this benefit was outweighed by an increased risk of new infection. Considering all recurrent infections, the efficacy of AQ + SP was at least as efficacious at all sites and superior to AQ + AS at the highest transmission sites. The high endemicity of malaria in Africa may impact on the efficacy of artemisinin-based combination therapy. The registration number for this trial is ISRCTN67520427 (http://www.controlled-trials.com/isrctn/trial/|/0/67520427.html).

Amodiaquine↗
PubMed2005

Sulfadoxine-pyrimethamine plus chloroquine or amodiaquine for uncomplicated falciparum malaria: a randomized, multisite trial to guide national policy in Uganda.

The use of combinations of inexpensive drugs for the treatment of malaria in Africa has been proposed as an interim policy while awaiting the widespread availability of more effective regimens. We compared sulfadoxine-pyrimethamine plus chloroquine or amodiaquine in three districts in Uganda. Patients aged 6 months or greater with uncomplicated falciparum malaria were enrolled and randomized to therapy. Safety, tolerability, and efficacy outcomes, adjusted by genotyping, were assessed over 28 days. Of 1,105 patients enrolled, 1,057 (96%) completed follow-up. For children less than 5 years old, the risk of clinical treatment failure adjusted by genotyping at the three sites ranged from 34% to 67% with chloroquine plus sulfadoxine-pyrimethamine and from 13% to 35% with amodiaquine plus sulfadoxine-pyrimethamine (risk differences 21-32%, P < 0.0001 at all sites). Serious adverse events were uncommon with both regimens. The risk of treatment failure with chloroquine plus sulfadoxine-pyrimethamine, the current standard in Uganda, was unacceptably high. Amodiaquine plus sulfadoxine-pyrimethamine was significantly more efficacious; however, existing levels of resistance raises concern about the useful therapeutic life-span of this regimen.

Amodiaquine↗
PubMed2004

Thirteen years HIV-1 sentinel surveillance and indicators for behavioural change suggest impact of programme activities in south-west Tanzania.

OBJECTIVE: To describe the evolution of the HIV-1 epidemic among women attending antenatal clinics in four different geographic areas within two rural regions with differing intervention intensity in south-west Tanzania. DESIGN AND METHODS: Age-specific trends in HIV-1 seroprevalence among antenatal clinic attendees in four distinct geographic areas of Mbeya region between 1988 and 2000 and in one area of Rukwa region between 1991 and 1999 were analysed and compared. In Mbeya region a comprehensive AIDS control programme has been implemented since 1988. Indicators measuring behavioural change and the attendance rate of patients with sexually transmitted diseases (STDs) were monitored through the established routine system, complemented by two Knowledge, Attitude and Practise (KAP) surveys in 1995 and 1999. RESULTS: Data showed an increasing HIV-1 prevalence from 1988 up to 1994/95 for women in the age group 15-24 years across all strata. Between 1994/95 and 2000 the prevalence declined significantly in all strata for this age group in Mbeya region with diverse patterns in spread of the infection accompanied by a significant decrease in the positive syphilis serology, high rate of condom use, significant delay of age for the start of sexual activity of primary school pupils and a high treatment rate for STDs. The increasing trend of the HIV-1 prevalence in Rukwa region continued. CONCLUSION: Declining trends of HIV-1 prevalence among women aged 15-24 years may correspond to a reduced incidence partially attributable to changes in behaviour and reduction of a biological factor influencing HIV-1 transmission to which the implemented programme could contribute.

Adolescent↗