E-DRUG: HIV drug improves anti-malarial drug effectiveness
21 March 2012
An antiretroviral drug commonly given to HIV-infected children in Sub-Saharan
Africa improves the effectiveness of a key malaria drug, according to a new
Laboratory studies have long established that a class of HIV antiretrovirals
known as protease inhibitors can cripple the malaria parasite Plasmodium, and
researchers from Uganda and the United States wanted to better understand why.
They tested two antiretroviral 'cocktails' on 170 HIV-positive Ugandan children
under the age of five. One of the cocktails contained two protease inhibitors,
lopinavir and ritonavir.
Over the course of the two-year trial, children who received the cocktail
containing the inhibitors had a 41 per cent drop in malaria cases compared with
children who did not.
"The 41 per cent reduction in clinical malaria episodes is both statistically
and clinically significant," Paula Brentlinger, a clinician at the University
of Washington, Seattle, told ScienceNOW. "The fact that it was achieved in one
of the most malaria-vulnerable populations in the world is especially
To their surprise, the researchers found that the two protease inhibitors had a
limited impact on the malaria parasite itself. However they found one of the
inhibitors ritonavir boosted the longevity in the body of a widely used
anti-malarial drug, lumefantrine.
Children who received anti-retroviral cocktails containing ritonavir had five
times as much lumefantrine in their bodies a week after receiving the
"We think that these higher lumefantrine exposures were really what was driving
the protection against recurrent episodes of malaria," said Jane Achan, a
researcher at Makerere University, Uganda, who presented the results of the
study earlier this month.
Carlos "Kent" Campbell, head of the Malaria Control Program at PATH, a US-based
nonprofit organisation, said bednets remain the most critical prevention
strategy and said most children at risk of malaria are not HIV-positive.
But he added that the "unanticipated positive consequences" of ritonavir may
help reduce parasitemia, a leading malaria-related cause of anaemia in young
S. Patrick Kachur, director of the Centre for Disease Control's malaria
programme, also said the finding could benefit investigations into long-acting
antimalarials for specific populations.
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