{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T14:01:41Z","timestamp":1758808901159},"reference-count":20,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,6]]},"abstract":"<jats:p>Trimethoprim\u2013sulfamethoxazole (TMP\u2013SMX) prophylaxis in HIV-uninfected, exposed (HUE) children variably reduces clinical malaria burden despite antifolate resistance, but data regarding achieved serum levels and adherence are lacking. Serum samples from 70 HUE children aged 3\u201312 months from Rakai, Uganda, enrolled in an observational study were assayed for random SMX levels using a colorimetric assay. Adherence with TMP\u2013SMX prophylaxis data (yes\/no) was also collected. Of 148 visits with concurrent SMX levels available, 56% had self-reported adherence with TMP\u2013SMX therapy. Among these 82 visits, mean (standard deviation) level was 19.78 (19.22) \u00b5g\/mL, but 33% had SMX levels below half maximal inhibitory concentrations (IC50) for <jats:italic>Plasmodium falciparum<\/jats:italic> with some, but not all, of the reported antifolate resistance mutations reported in Uganda. With TMP\u2013SMX prophylaxis, suboptimal adherence is concerning. Sulfamethoxazole levels below IC50s required to overcome malaria parasites with multiple antifolate resistance mutations may be significant. Further study of TMP\u2013SMX in this context is needed.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0933","type":"journal-article","created":{"date-parts":[[2018,4,24]],"date-time":"2018-04-24T07:00:35Z","timestamp":1524553235000},"page":"1718-1721","source":"Crossref","is-referenced-by-count":1,"title":["Sulfamethoxazole Levels in HIV-Exposed Uninfected Ugandan Children"],"prefix":"10.4269","volume":"98","author":[{"given":"Jingo","family":"Kasule","sequence":"first","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda;"},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erin E.","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aggrey","family":"Anok","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda;"},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jillian","family":"Neal","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard T.","family":"Eastman","sequence":"additional","affiliation":[{"name":"Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott","family":"Penzak","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of North Texas, Fort Worth, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Newell","sequence":"additional","affiliation":[{"name":"Clinical Research Directorate\/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., National Cancer Institute Campus at Frederick, Frederick, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Serwadda","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda;"},{"name":"School of Public Health, Makerere College of Health Sciences, Kampala, Uganda;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick E.","family":"Duffy","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven J.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda;"},{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte V.","family":"Hobbs","sequence":"additional","affiliation":[{"name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland;"},{"name":"University of Mississippi Medical Center, Batson Children\u2019s Hospital, Jackson, Mississippi"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Lancet Infect Dis","first-page":"541","article-title":"Consequences of 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