The yield from an National Institutes of Health-funded study could improve the odds for children living with HIV in malaria-prone areas, showing that an antiretroviral treatment that has not been commonly used in those areas can add to the protection offered by anti-malaria drugs.
The treatment includes a combination of two drugs — lopinavir and ritonavir– which was also recently shown to treat HIV more effectively in children than the currently most commonly used treatments.
The treatment has not been widely used in resource-poor settings, said Dr. George Siberry, Medical Officer of the Maternal and Pediatric Infectious Disease branch of the National Institutes of Child Health and Human Development, because it has come with formidable logistical barriers to widespread routine use in those settings: It has been more expensive than other available treatment, requires refrigeration, and in the liquid form necessary for children, has an extremely unpleasant taste.
The latest study adds a new argument for addressing those barriers, showing a 40-percent overall reduction of malaria incidence in HIV-positive children taking the lopinavir-ritonavir antiretroviral combination, with anti-malaria medicine, compared to the incidence among HIV-positive children taking anti-malaria medicine and the currently more commonly used antiretroviral treatment — nevirapine for children under three, and efavirenz for older children. The incidence reduction came largely from a significantly reduced rate of recurrence of malaria infections. The findings suggest a synergistic effect between the combination of the boosted lopinavir regimen and the anti-malaria medicine, that prolongs the effectiveness of the anti-malaria medicine, Siberry said.
“This is very exciting,” Siberry said.
The findings, from a study of more than 170 children in a high-HIV, high-malaria area of Uganda, add “counter-balance” to the obstacles currently standing in the way of widespread use of the lopinavir combination, Siberry said.
Already, work to reduce the price of the treatment has had an impact, and work is in progress to develop formulations that are more palatable and don’t require refrigeration.