Artemisinin-based combination therapies are efficacious and safe for treatment of uncomplicated malaria in HIV-infected Ugandan children.

Abstract

BACKGROUND:

Artemisinin-based combination therapies (ACTs) are highly efficacious and safe, but data from human immunodeficiency virus (HIV)-infected children concurrently receiving antiretroviral therapy (ART) and ACTs are limited.

METHODS:

We evaluated 28-day outcomes following malaria treatment with artemether-lumefantrine (AL) or dihydroartemisinin-piperaquine (DP) in 2 cohorts of HIV-infected Ugandan children taking various ART regimens. In one cohort, children <6 years of age were randomized to lopinavir/ritonavir (LPV/r) or nonnucleoside reverse transcriptase inhibitor-based ART and treated with AL for uncomplicated malaria. In another cohort, children <12 months of age were started on nevirapine-based ART if they were eligible, and randomized to AL or DP for the treatment of their first and all subsequent uncomplicated malaria episodes.

RESULTS:

There were 773 and 165 treatments for malaria with AL and DP, respectively. Initial response to therapy was excellent, with 99% clearance of parasites and <1% risk of repeat therapy within 3 days. Recurrent parasitemia within 28 days was common following AL treatment. The risk of recurrent parasitemia was significantly lower among children taking LPV/r-based ART compared with children taking nevirapine-based ART following AL treatment (15.3% vs 35.5%, P = .009), and those treated with DP compared with AL (8.6% vs 36.2%, P < .001). Both ACT regimens were safe and well tolerated.

CONCLUSIONS:

Treatment of uncomplicated malaria with AL or DP was efficacious and safe in HIV-infected children taking ART. However, there was a high risk of recurrent parasitemia following AL treatment, which was significantly lower in children taking LPV/r-based ART compared with nevirapine-based ART.

• Authors: Abel Kakuru, Jane Achan, Mary K Muhindo, Gloria Ikilezi, Emmanuel Arinaitwe, Florence Mwangwa, Theodore Ruel, Tamara D Clark, Edwin Charlebois, Philip J Rosenthal, Diane Havlir, Moses R Kamya, Jordan W Tappero, Grant Dorsey
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 59 Issue 3 Pg. 446-53 (Aug 01 2014) ISSN: 1537-6591 [Electronic] United States
• PMID: 24759826 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• Antimalarials
• Artemisinins
• HIV Protease Inhibitors
• Quinolines
• Reverse Transcriptase Inhibitors
• Lopinavir
• artenimol
• Nevirapine
• artemisinin
• piperaquine
• Ritonavir

Topics

• Antimalarials (therapeutic use)
• Artemisinins (therapeutic use)
• Child, Preschool
• Cohort Studies
• Drug Therapy, Combination
• Female
• HIV Infections (drug therapy)
• HIV Protease Inhibitors (therapeutic use)
• Humans
• Infant
• Lopinavir (therapeutic use)
• Malaria (drug therapy)
• Male
• Nevirapine (therapeutic use)
• Parasitemia (drug therapy)
• Quinolines (therapeutic use)
• Reverse Transcriptase Inhibitors (therapeutic use)
• Ritonavir (therapeutic use)
• Treatment Outcome
• Uganda