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Clin Infect Dis. 2014 Aug 1;59(3):446-53. doi: 10.1093/cid/ciu286. Epub 2014 Apr 23.

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

Author information

1
Infectious Diseases Research Collaboration.
2
Infectious Diseases Research Collaboration Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda.
3
Department of Pediatrics.
4
Department of Medicine, University of California, San Francisco.
5
Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
6
Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, Georgia.

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.

KEYWORDS:

ACTs; ART; HIV; children; malaria

PMID:
24759826
PMCID:
PMC4155440
DOI:
10.1093/cid/ciu286
[Indexed for MEDLINE]
Free PMC Article

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