Abstract
.Laboratory data and prior pediatric reports indicate that HIV protease inhibitor (PI)–based antiretroviral therapy (ARV) kills gametocytes and reduces rates of gametocytemia, but not asymptomatic parasitemia, in a high malaria-transmission area. To determine whether ARV regimen impacts these rates in areas with less-intense malaria transmission, we compared asymptomatic parasitemia and gametocytemia rates in HIV-infected children by ARV regimen in Lilongwe, Malawi, an area of low-to-moderate transmission intensity. HIV PI lopinavir–ritonavir (LPV–rtv) ARV– or non-nucleoside reverse transcriptase inhibitor nevirapine ARV–treated children did not differ in the rates of polymerase chain reaction-detected asymptomatic parasitemia (relative risk [RR] 0.43 95% confidence interval [CI] [0.16, 1.18], P value 0.10) or microscopically detected gametocytemia with LPV–rtv ARV during symptomatic malaria (RR 0.48 95% CI [0.22,1.04] P value 0.06). LPV–rtv ARV was not associated with reduced rates of asymptomatic parasitemia, or gametocytemia on days of symptomatic malaria episodes, in HIV-infected children. Larger studies should evaluate whether ARV impacts transmission.
Highlights
HIV and malaria occur co-endemically in sub-Saharan Africa.[1]
LPV–rtv antiretroviral therapy (ARV) was not associated with reduced rates of asymptomatic parasitemia, or gametocytemia on days of symptomatic malaria episodes, in HIV-infected children
We recently reported an association between increased time to recurrent positive malaria blood smears in LPV–rtv ARV–treated subjects compared with nevirapine (NVP) ARV–treated subjects, when accounting for an LPV–rtv and antimalarial treatment interaction, in an observational pediatric study.[10]
Summary
HIV and malaria occur co-endemically in sub-Saharan Africa.[1]. Laboratory data show that HIV protease inhibitors (PIs) kill various life cycle stages of malaria parasites.[2,3,4,5,6] PIs are second-line World Health Organization (WHO)-recommended antiretroviral therapy (ARV) for children above 3 years old and first-line ARV for those below 3 years.[7]. Because malaria transmission intensity influences malaria infection and intervention efficacy, we evaluated the malaria impact of different ARV regimens in HIV-infected children by measuring asymptomatic parasitemia and gametocytemia in an area of low-to-moderate transmission. We recently reported an association between increased time to recurrent positive malaria blood smears in LPV–rtv ARV–treated subjects compared with nevirapine (NVP) ARV–treated subjects, when accounting for an LPV–rtv and antimalarial treatment interaction, in an observational pediatric study.[10] we measure and compare rates of asymptomatic parasitemia and gametocytemia in children receiving differing ARV regimens
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