Format

Send to

Choose Destination
J Acquir Immune Defic Syndr. 2018 Oct 1;79(2):249-254. doi: 10.1097/QAI.0000000000001783.

Brief Report: Antimalarial Benefit of HIV Antiretroviral Therapy in Areas of Low to Moderate Malaria Transmission Intensity.

Author information

1
Department of Mathematics, Siena College, Loudonville, NY.
2
Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD.
3
Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, New York, NY.
4
Department of Microbiology, University of Mississippi Medical Center, Jackson, MS.
5
Yale School of Public Health, New Haven, CT.

Abstract

BACKGROUND:

We previously used mathematical modeling to predict reduced malaria incidence in children with protease inhibitor (PI)-, compared with nonnucleoside reverse transcriptase inhibitor-, based highly active antiretroviral therapy (HAART), in moderate to high malaria transmission areas. These effects were accounted for, in part, by pharmacokinetic (PK) interactions between PIs and artemether-lumefantrine (AL).

OBJECTIVE:

Because of potentially reduced malaria transmission reservoirs in HIV-infected children due to PI/AL PK interactions impacting non-HIV-infected children, we estimate the antimalarial benefit of PI-based HAART in all children, and in HIV-infected children only residing in low to moderate malaria transmission areas.

DESIGN:

A dynamic model of malaria transmission was developed to evaluate the PK interaction of PI-based HAART with the antimalarial, AL for preventing malaria.

METHODS:

To evaluate the benefit of HIV PI-based HAART on malaria incidence, a malaria transmission model with varying degrees of HIV newborn prevalence was developed using recent pediatric clinical trial data in Lilongwe, Malawi.

RESULTS:

Comparing situations of low to high HIV newborn prevalence, and low to moderate malaria transmission intensities, our model predicts the combination of PI-based HAART with AL-treated malaria prevents 0.04-24.8 and 0.05-34.5 annual incidences of malaria overall per 1000 children, and saves 0.003-1.66 and 0.003-2.30 disability-adjusted life years per 1000 children, respectively. When incorporating seasonality, 0.01-7.3 and 0.01-5.9 annual incidences of malaria overall per 1000 children, and 0.0-0.5 and 0.001-0.41 disability-adjusted life years per 100 children, are prevented, respectively.

CONCLUSIONS:

In low to moderate malaria transmission intensity areas, PI-based HAART may reduce malaria events in children when AL is used.

Supplemental Content

Full text links

Icon for Wolters Kluwer
Loading ...
Support Center