Hobbs Charlotte V, Gabriel Erin E, Kamthunzi Portia, Tegha Gerald, Tauzie Jean, Petzold Elizabeth, Barlow-Mosha Linda, Chi Benjamin H, Li Yonghua, Ilmet Tiina, Kirmse Brian, Neal Jillian, Parikh Sunil, Deygoo Nagamah, Jean Philippe Patrick, Mofenson Lynne, Prescott William, Chen Jingyang, Musoke Philippa, Palumbo Paul, Duffy Patrick E, Borkowsky William
Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States of America.
Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, NY, United States of America.
PLoS One. 2016 Dec 9;11(12):e0165140. doi: 10.1371/journal.pone.0165140. eCollection 2016.
HIV and malaria geographically overlap. HIV protease inhibitors kill malaria parasites in vitro and in vivo, but further evaluation in clinical studies is needed.
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.
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).
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.
ClinicalTrials.gov NCT00719602.
HIV与疟疾在地理分布上重叠。HIV蛋白酶抑制剂在体外和体内均可杀死疟原虫，但仍需在临床研究中进行进一步评估。
对来自马拉维的31名年龄在4至62个月的儿童，每3个月进行一次随访，并在出现并发疾病时进行≤47个月（2009年9月至2011年12月）的随访。我们比较了接受齐多夫定、拉米夫定联合奈韦拉平（NVP，一种非核苷类逆转录酶抑制剂）或洛匹那韦-利托那韦（LPV-rtv，一种蛋白酶抑制剂）的HIV抗逆转录病毒治疗（ART）的儿童，通过血涂片显微镜检查（BS）检测到的疟原虫携带情况以及确诊的临床疟疾发病率（CCM，即BS阳性且伴有疟疾症状）。
我们发现，在同时使用抗疟疾治疗和基于LPV-rtv的ART时，考虑到LPV-rtv与抗疟疾治疗的相互作用，复发性阳性BS出现时间增加，但CCM未增加（调整后的风险比0.39；95%置信区间(0.17,0.89)；p = 0.03）。
在感染HIV的儿童中，LPV-rtv与疟疾治疗联合使用与复发性阳性BS风险降低相关，但与CCM无关。需要进行更大规模的随机研究来证实这些发现，这可能有助于在疟疾流行地区优化ART方案。
ClinicalTrials.gov NCT00719602。
