Department of Clinical Pharmacy and Management, Faculty of Pharmaceutical Sciences, University of Port Harcourt, Rivers State, Nigeria.
Antimicrob Agents Chemother. 2013 Sep;57(9):4146-50. doi: 10.1128/AAC.02508-12. Epub 2013 Jun 17.
Management of coinfection with malaria and HIV is a major challenge to public health in developing countries, and yet potential drug-drug interactions between antimalarial and antiviral regimens have not been adequately investigated in people with both infections. Each of the constituent components of artemether-lumefantrine, the first-line regimen for malaria treatment in Nigeria, and nevirapine, a major component of highly active antiretroviral therapy, are drugs metabolized by the cytochrome P450 3A4 isoenzyme system, which is also known to be induced by nevirapine. We examined potential interactions between lumefantrine and nevirapine in 68 HIV-positive adults, all of whom were diagnosed with asymptomatic Plasmodium falciparum infections by microscopy. Post hoc PCR analysis confirmed the presence of P. falciparum in only a minority of participants. Day 7 capillary blood levels of lumefantrine were significantly higher in HIV-positive participants than in 99 HIV-negative controls (P = 0.0011). Associations between day 7 levels of lumefantrine and risk of persistent parasitemia could not be evaluated due to inadequate power. Further investigations of the impact of nevirapine on in vivo malaria treatment outcomes in HIV-infected patients are thus needed.
疟疾和 HIV 合并感染的管理是发展中国家公共卫生的主要挑战，但在同时患有这两种感染的人群中，抗疟和抗病毒方案之间的潜在药物相互作用尚未得到充分研究。青蒿琥酯-咯萘啶是尼日利亚治疗疟疾的一线方案，奈韦拉平是高效抗逆转录病毒疗法的主要成分，这两种药物的组成部分都是细胞色素 P450 3A4 同工酶系统代谢的药物，而该酶系统也已知会被奈韦拉平诱导。我们在 68 名 HIV 阳性成年人中检查了咯萘啶和奈韦拉平之间的潜在相互作用，所有这些成年人都是通过显微镜诊断为无症状疟原虫感染的。事后 PCR 分析仅证实少数参与者存在疟原虫。第 7 天 HIV 阳性参与者的青蒿琥酯毛细管血药水平明显高于 99 名 HIV 阴性对照者（P=0.0011）。由于缺乏足够的效力，无法评估第 7 天青蒿琥酯水平与持续性寄生虫血症风险之间的关系。因此，需要进一步研究奈韦拉平对 HIV 感染患者体内疟疾治疗结果的影响。
