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[afro-nets] Drug against AIDS-related infections also prevents malaria

Drug combo against AIDS-related infections also prevents malaria

19 October, 2005
Infectious Diseases Society of America

A drug combination used to prevent pneumonia and opportunistic
bacterial infection in persons with HIV/AIDS has unexpectedly
been found to be highly effective at preventing malaria, accord-
ing to a study published in the November 15 issue of The Journal
of Infectious Diseases, now available online.

The combination, trimethoprim-sulfamethoxazole (TS), is known to
reduce morbidity and mortality from certain opportunistic infec-
tions in HIV-infected individuals, and is widely recommended for
individuals with advanced disease, both in developed and devel-
oping countries. In addition, TS shares many properties --
including resistance patterns -- with a leading anti-malarial
therapy, sulfadoxine-pyrimethamine (SP), causing concern that
widespread use of TS prophylaxis might increase the number of
malarial parasite strains resistant to SP treatment, thereby in-
creasing the risk that SP treatment may fail in HIV-infected in-
dividuals who contract malaria.

These concerns prompted Christopher V. Plowe, MD, MPH, and col-
leagues at the University of Maryland School of Medicine and the
Malaria Research and Training Center at the University of Bamako
to conduct a study to determine whether TS prophylaxis impairs
SP efficacy for treating malaria. The investigators studied 160
children (aged 5-15 years) given TS prophylaxis and 80 children
in a control group receiving no preventive treatment in Mali,
where malaria is endemic and rates of HIV infection in children
are low. Plowe and colleagues were expecting to compare the suc-
cess of SP treatment on malarial episodes in both groups. What
they encountered, however, was just a single clinical episode of
malaria in the TS group, and the infected individual had an ade-
quate clinical and parasitological response to SP. In the con-
trol group, there were 72 episodes of malaria and three in-
stances of SP failure.

Lack of malarial episodes in the TS group precluded meaningful
comparison of SP efficacy in the TS and control groups, but, im-
portantly, TS was shown to be a highly effective prophylactic
agent against malaria in this population, reducing the incidence
by 99.5%.

In addition to being protected against malaria, children in the
TS group also experienced fewer gastrointestinal illnesses and
had slightly higher hemoglobin levels than those in the control
group. The authors pointed out that such benefits did not mean
that routine TS prophylaxis should be used in healthy children
but that they did "mitigate concerns about TS use in HIV-exposed
children whose HIV status is not yet known."

Although the authors cautioned that studies of SP efficacy in
persons taking TS prophylaxis are still needed and that SP
should be used only with caution in those taking TS who contract
malaria, "based on the results of this study and the clear evi-
dence that TS prevents death in persons living with HIV in a va-
riety of African settings, concerns about spreading SP resis-
tance do not justify further delays in implementing TS prophy-

Founded in 1904, The Journal of Infectious Diseases is the pre-
mier publication in the Western Hemisphere for original research
on the pathogenesis, diagnosis, and treatment of infectious dis-
eases; on the microbes that cause them; and on disorders of host
immune mechanisms. Articles in JID include research results from
microbiology, immunology, epidemiology, and related disciplines.
JID is published under the auspices of the Infectious Diseases
Society of America (IDSA). Based in Alexandria, Va., IDSA is a
professional society representing about 8,000 physicians and
scientists who specialize in infectious diseases. For more in-
formation, visit

Steve Baragona
Infectious Diseases Society of America

Leela McCullough, Ed.D.
Director of Information Services
30 California Street, Watertown, MA 02472, USA
Tel: 617-926-9400
Fax: 617-926-1212

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