Researchers revealed at the 19th Conference on Retroviruses and Opportunistic Infections clinical data showing anti-retroviral drugs coupled with standard anti-malaria treatment greatly improves the efficacy of the malaria treatment. The study was done by a team of researchers headed by Diane Havlir of the University of California, San Francisco (UCSF), and Moses Kamya of Makerere University College of Health Sciences in Uganda
The data, presented by Jane Achan,
showed that treatment with protease inhibitors lopinavir and ritonavir
(two anti-retrovirals) resulted in a 41% drop in malaria cases. Breaking
the data down even further revealed a 29% reduction in first malaria
cases, or cases in which the children had no previous malaria infection.
When they isolated reinfections they found a 59% reduction. These drugs
are mildly protective against an initial infection, but are very good
at blocking a secondary infection. Why is that?
anti-malaria drug, Lumefantrine, can stay in the body for several weeks,
extending the length of time the drug protects. Ritonavir is a protease
inhibitor that has little effect on HIV, but instead prevents the body
from breaking down other HIV drugs and improving the effectiveness of
the treatment. It appears that it provides the same effect for
anti-malaria drugs as it does for anti-retroviral drugs. When they
looked in the blood of children in the treatment groups they found
fivefold more lumefantrine in the group that also received the protease
"We think that these higher lumefantrine exposures
were really what was driving the protection against recurrent episodes
of malaria," Achan said.
It appears that once again, the HIV world has turned science dogma on its head.
always think of drug-drug interactions as something to be avoided, but
HIV has taught us the opposite," says Paul Volberding, an HIV/AIDS
clinician at UCSF.
These findings could alter how treatment
occurs in areas with high incidence of both HIV and malaria.
Additionally, the study could change how long term prophylactic malaria
treatment is done.