title: Challenges in the concurrent management of malaria and HIV in pregnancy in sub-Saharan Africa.
abstract: Approximately one million pregnancies are complicated by both malaria and HIV infection in sub-Saharan Africa annually. Both infections have been associated with maternal and infant morbidity and mortality. Intermittent preventive treatment, usually with sulfadoxine-pyrimethamine, has been shown to prevent pregnancy-related malaria and its complications. Several different regimens of antiretroviral therapy are now available to prevent mother-to-child transmission of HIV and/or progression of maternal HIV infection during pregnancy. However, no published studies have yet shown whether standard intermittent preventive treatment and antiretroviral regimens are medically and operationally compatible in pregnancy. We reviewed existing policies regarding prevention and treatment of HIV and malaria in pregnancy, as well as published literature on adverse effects of antiretrovirals and antimalarials commonly used in pregnancy in developing countries, and found that concurrent prescription of sulfadoxine-pyrimethamine, co-trimoxazole (trimethoprim-sulfamethoxazole), and antiretroviral agents including nevirapine and zidovudine per existing protocols for prevention of malaria and vertical HIV transmission may result in adverse drug interactions or overlapping, diagnostically challenging drug toxicities. Insecticide-treated bednets should be provided for HIV-infected pregnant women at risk for malaria. Sulfadoxine-pyrimethamine should be prescribed cautiously in women concurrently receiving daily nevirapine and/or zidovudine, and should be avoided in women on daily co-trimoxazole. Further research is urgently needed to define safe and effective protocols for concurrent management of HIV and malaria in pregnancy, and to define appropriate interventions for different populations subject to differing levels of malaria transmission and antimalarial drug resistance.
authors.affiliation: Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195-7660, USA. brentp2@u.washington.edu
authors.forename: Paula E
authors.initials: PE
authors.lastname: Brentlinger
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Behrens
authors.forename: Mark A
authors.initials: MA
authors.lastname: Micek
mesh_terms: D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000962:Antimalarials / Q000009:adverse effects / Q000627:therapeutic use*; D001512:Bedding and Linens; D004347:Drug Interactions; D004351:Drug Resistance; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007306:Insecticides / Q000494:pharmacology; D008288:Malaria / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000517:prevention & control
chemical_list: D019380:Anti-HIV Agents; D000962:Antimalarials; D007306:Insecticides