Effect of antiretroviral therapy on malaria incidence in HIV-infected Ugandan adults

2017-05-03

Data from a cotrimoxazole cessation study in Ugandan HIV-positive adults was used to evaluate the effect of antiretroviral therapy on the incidence of malaria. Patients with more than 250 CD4+ cells/μL were randomized to receive placebo or cotrimoxazole. Irrespective of cotrimoxazole use they were categorized into three groups according to antiretroviral therapy; nucleoside reverse transcriptase inhibitor (NRTI) only, non nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen or protease inhibitor (PI)-regimen. Blood slides for malaria microscopy were examined at scheduled visits and at unscheduled visits when the participant felt sick. The original purpose of the study was to evaluate if cotrimoxazole could be safely discontinued in HIV-positive adults with more than 250 CD4+ cells/μL. The trial enrolled 2180 participants A vast majority of the patients started on an NNRTI-containing regimen in accordance with WHO recommendations. 86 patients (4 %) were on a PI-containing (mostly lopinavir/ritonavir) regimen at study inclusion and 1 % were treated with NRTI only. During the study 10 patients switched to a PI-containing therapy. 447 episodes of malaria were observed during the study. Malaria incidence per 100 person years was 9.9 in the NRTI only group, 9.3 in the NNRTI group and 3.5 in the PI group. Due to the low number of participants the confidence interval for the PI group was wide and the difference just reached statistical significance. Stratification for cotrimoxazole gave similar results.

Kasirye et al. AIDS 2017;31:577-582

Comment: The positive effect of protease inhibitor use on malaria in African children has been reported in earlier studies. The present study was not originally designed to evaluate the effect of different antiretroviral therapies on the malaria incidence. Nevertheless the study results indicate that the choice of antiretroviral regimen in malaria endemic regions may have important impact on public health not only from a strict HIV-perspective.