Editors' ChoiceInfectious diseases

Closing the Door on Malaria

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Science Translational Medicine  12 Dec 2012:
Vol. 4, Issue 164, pp. 164ec225
DOI: 10.1126/scitranslmed.3005443

Synergies between human immunodeficiency virus (HIV) infection and other infectious diseases generally threaten the health of the human host. For example, malaria coinfection I increases the amount of HIV in the body and consequently heightens the risk of transmission to an uninfected partner. Other coinfections—sexually transmitted diseases in particular—also are known to increase the risk of acquiring HIV. As a result of these synergies, regions of the world that have a high burden of infectious diseases in general often also have a high HIV burden. In an innovative study, Achan and colleagues report the effect of both HIV and malaria treatment on reducing recurrent episodes of malaria among children, a welcome outcome for synergies.

The authors followed 170 HIV-infected children who received either antiretroviral therapy (ART) for HIV that boosts the levels of standard malaria medication (lopinavir-ritonavir–based ART) or ART that does not interact with malaria drugs (nonnucleoside-reverse-transcriptase-inhibitor–based ART). In this cohort, malaria cases were treated with artemether-lumefantrine, and lumefantrine concentrations were boosted by lopinavir-ritonavir. The number of new cases of malaria and the risk of malaria recurrence were significantly lower (41 and 59%, respectively) among children on the lopinavir-ritonavir–based ART. The decrease in new cases of malaria stemmed largely from the reduction in recurrent malaria after treatment. The authors hypothesized that this effect resulted from higher concentrations of lumefantrine, which they observed (on treatment day 7) in the lopinavir-ritonavir–based ART group relative to the group treated with nonnucleoside-reverse-transcriptase-inhibitor–based ART. There was a trend toward more series side effects in the lopinavir-ritonavir–based ART group; however, the study size was too small to assess adverse effects completely.

Children with HIV infection face serious health challenges from other infectious diseases, such as malaria. In areas of the world where malaria transmission is high, use of lopinavir-ritonavir–based ART may have the advantage of preventing malaria recurrences after malaria treatment. There are challenges with cost and storage requirements of the lopinavir-ritonavir–based ART, but new heat-stable formulations may make more widespread use of these regimens possible. Indeed, synergies between infectious disease treatments that work in favor of the human host would be a welcome turn of events.

J. Achan et al., Antiretroviral agents and prevention of malaria in HIV-infected Ugandan children. N. Engl. J. Med. 367, 2110–2118 (2012). [PubMed]

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