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ART regimen protects children from malaria

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8214 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8214

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A preliminary trial from Uganda suggests that some antiretroviral treatments (ART) for HIV can also help prevent malaria in children. Children treated for HIV with a regimen based on lopinavir and ritonavir had significantly fewer episodes of falciparum malaria than controls treated with a plan based on non-nucleoside reverse transcriptase inhibitors (NNRTIs) (1.32 v 2.25 episodes per person year; incidence rate ratio 0.59, 95% CI 0.36 to 0.97). The difference was driven by a large decrease in recurrences among children given lopinavir and ritanovir.

All episodes of malaria were treated with artemether and lumefantrine. Children taking lopinavir and ritonavir had significantly higher serum concentrations of lumefantrine than controls. The likeliest explanation is that their antiretroviral regimen inhibited metabolism of lumefantrine, boosting exposure and preventing recurrences of malaria, say the authors. Higher concentrations of lumefantrine were associated with significantly more pruritis in this group (5.6% v 1.2%; P=0.04). The authors report 10 serious adverse events overall and judge that just three were linked to study drugs: one child taking the NNRTI regimen developed Stevens-Johnson syndrome and two children taking lopinavir and ritonavir developed neutropenia.

The trial wasn’t big enough to establish the safety of the antimalarial ART regimen and further trials should now be done, say the authors. Not least to see if these promising results extrapolate to areas with a lower incidence of malaria. The 176 children in this study had 285 new episodes of malaria during an average follow-up of one year.

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Cite this as: BMJ 2012;345:e8214