Management of HIV-infected pregnant patients in malaria-endemic areas: therapeutic and safety considerations in concomitant use of antiretroviral and antimalarial agents.
Chemotherapy in pregnancy is an intricate process requiring prudent use of pharmacologic agents. Malarial infection during pregnancy is often fatal, and prophylaxis against the causative parasite necessitates rational therapeutic intervention. Various agents have been used for prophylaxis against malaria during pregnancy, including chloroquine, mefloquine, proguanil, pyrimethamine, and pyrimethamine-sulfadoxine. Use of these agents has been based on a risk-benefit criterion, without appropriate toxicologic or teratologic evaluation. Some of the aforementioned prophylactic agents have been shown to alter glutathione levels and may exacerbate the oxidation-reduction imbalance attendant on HIV infection. HIV-infected patients traveling to or residing in malaria-endemic areas require protection from malarial infection to avoid placing themselves in double jeopardy. Zidovudine (AZT) is recommended for the prevention of vertical transmission of HIV-1 from mother to child. Other agents, such as lamivudine alone or in combination with AZT, nevirapine, or the HIV-1 protease inhibitors, are either being considered or are currently undergoing trials for use in preventing vertical transmission of HIV-1 or managing HIV infection in infants and children. Although the potential for antimalarial agents to cause congenital malformations is low when they are used alone, their ability to cause problems when combined with antiretroviral drugs needs to be evaluated. In developing countries that have high birth rates, a high endemicity of malaria, and alarming rates of new cases of HIV, prophylaxis against both diseases with combination agents during pregnancy is a challenge.
Okereke
C S
CS
Department of Pharmacy Practice, University of Rhode Island College of Pharmacy, Roger Williams Medical Centre, Providence, USA.
D000962:Antimalarials / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015897:Comorbidity; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008288:Malaria / Q000150:complications* / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious
D000962:Antimalarials; D000998:Antiviral Agents