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Scientific title: Interactions between the antimalarial combination artemether/lumefantrine and antiretroviral therapy including nevirapine or lopinavir/ritonavir in HIV-infected adults
What did we know before this research?
Several African countries are heavily affected by both HIV/AIDS and malaria. The World Health Organization and ministries of health in most endemic countries recommend the use of artemisinin-based combination therapy (ACT) for malaria and antiretroviral combination treatments (ART) for HIV/AIDS, and such treatments have become increasingly available.
The interactions that can happen in the body between HIV and malaria drugs are potentially clinically significant, but this has not been adequately defined in people living with HIV.
What does this study add?
We have conducted a series of studies to understand and inform what appropriate dosage of ACT drugs is needed to treat malaria in patients who are already taking HIV medication (antiretrovirals). The research analyses pharmacokinetic drug interactions, meaning the changes to malaria or HIV drug concentrations in the bodies of patients who are taking more than one type of medication. We also assessed the safety of drugs to identify any potential harms of these combinations.
The study was conducted in two phases. The first looked at the interaction between first-line HIV and malaria drugs in patients infected with HIV: one group already taking the most widely used first-line antiretroviral drug combination, and the other group not taking any antiretrovirals. The second phase compared drug interactions of the same first line ACT, with the most widely used second-line antiretroviral drugs.
The research team
Prof. Karen Barnes, University of Cape Town, South Africa
Dr T Kredo, University of Cape Town, South Africa
Dr J-S van der Walt, University of Cape Town, South Africa
Prof G Maartens, University of Cape Town, South Africa
Dr K Cohen, University of Cape Town, South Africa
Prof PJ Smith, University of Cape Town, South Africa
Prof F Little, University of Cape Town, South Africa
Prof Niklas Lindgårdh, Mahidol University, Bangkok, Kingdom of Thailand
Dr Lasse Vestergaard, Centre for International Health and Development, University of Copenhagen, Denmark
Latest on this research
Our results have shown that the drug exposure for the antimalarial lumefantrine was increased by the first-line antiretroviral nevirapine, and was increased even more by the second-line antiretroviral, lopinavir/ritonavir.
This interaction could enhance the efficacy of the malaria treatment, and our small study did not identify any harms caused by the use of these malaria and HIV treatments together in people living with HIV.
Results will be submitted for publication shortly. This work has motivated for the conduct of a pooled individual patient pharmacokinetic-pharmacodynamic analysis on ACT Consortium as well as non-ACT consortium studies on artemether-lumefantrine interactions with widely used antiretrovirals.