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Malaria in HIV-Infected Children Receiving HIV Protease-Inhibitor- Compared with Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy, IMPAACT P1068s, Substudy to P1060. 2016
Charlotte V Hobbs, and
Erin E Gabriel, and
Portia Kamthunzi, and
Gerald Tegha, and
Jean Tauzie, and
Elizabeth Petzold, and
Linda Barlow-Mosha, and
Benjamin H Chi, and
Yonghua Li, and
Tiina Ilmet, and
Brian Kirmse, and
Jillian Neal, and
Sunil Parikh, and
Nagamah Deygoo, and
Patrick Jean Philippe, and
Lynne Mofenson, and
William Prescott, and
Jingyang Chen, and
Philippa Musoke, and
Paul Palumbo, and
Patrick E Duffy, and
William Borkowsky, and
Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States of America.
BACKGROUND HIV and malaria geographically overlap. HIV protease inhibitors kill malaria parasites in vitro and in vivo, but further evaluation in clinical studies is needed. METHODS Thirty-one children from Malawi aged 4-62 months were followed every 3 months and at intercurrent illness visits for ≤47 months (September 2009-December 2011). We compared malaria parasite carriage by blood smear microscopy (BS) and confirmed clinical malaria incidence (CCM, or positive BS with malaria symptoms) in children initiated on HIV antiretroviral therapy (ART) with zidovudine, lamivudine, and either nevirapine (NVP), a non-nucleoside reverse transcriptase inhibitor, or lopinavir-ritonavir (LPV-rtv), a protease inhibitor. RESULTS We found an association between increased time to recurrent positive BS, but not CCM, when anti-malarial treatment and LPV-rtv based ART were used concurrently and when accounting for a LPV-rtv and antimalarial treatment interaction (adjusted HR 0.39; 95% CI (0.17,0.89); p = 0.03). CONCLUSIONS LPV-rtv in combination with malaria treatment was associated with lower risk of recurrent positive BS, but not CCM, in HIV-infected children. Larger, randomized studies are needed to confirm these findings which may permit ART optimization for malaria-endemic settings. BACKGROUND ClinicalTrials.gov NCT00719602.
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