title: HIV-positive nigerian adults harbor significantly higher serum lumefantrine levels than HIV-negative individuals seven days after treatment for Plasmodium falciparum infection.
abstract: Management of coinfection with malaria and HIV is a major challenge to public health in developing countries, and yet potential drug-drug interactions between antimalarial and antiviral regimens have not been adequately investigated in people with both infections. Each of the constituent components of artemether-lumefantrine, the first-line regimen for malaria treatment in Nigeria, and nevirapine, a major component of highly active antiretroviral therapy, are drugs metabolized by the cytochrome P450 3A4 isoenzyme system, which is also known to be induced by nevirapine. We examined potential interactions between lumefantrine and nevirapine in 68 HIV-positive adults, all of whom were diagnosed with asymptomatic Plasmodium falciparum infections by microscopy. Post hoc PCR analysis confirmed the presence of P. falciparum in only a minority of participants. Day 7 capillary blood levels of lumefantrine were significantly higher in HIV-positive participants than in 99 HIV-negative controls (P = 0.0011). Associations between day 7 levels of lumefantrine and risk of persistent parasitemia could not be evaluated due to inadequate power. Further investigations of the impact of nevirapine on in vivo malaria treatment outcomes in HIV-infected patients are thus needed.
authors.affiliation: Department of Clinical Pharmacy and Management, Faculty of Pharmaceutical Sciences, University of Port Harcourt, Rivers State, Nigeria.
authors.forename: Ifeyinwa
authors.initials: I
authors.lastname: Chijioke-Nwauche
authors.forename: Albert
authors.initials: A
authors.lastname: van Wyk
authors.forename: Chijioke
authors.initials: C
authors.lastname: Nwauche
authors.forename: Khalid B
authors.initials: KB
authors.lastname: Beshir
authors.forename: Harparkash
authors.initials: H
authors.lastname: Kaur
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000097:blood* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000097:blood* / Q000627:therapeutic use; D016022:Case-Control Studies; D060085:Coinfection; D004338:Drug Combinations; D004347:Drug Interactions; D004983:Ethanolamines / Q000097:blood* / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000097:blood* / Q000627:therapeutic use; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D016778:Malaria, Falciparum / Q000097:blood / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use*; D009549:Nigeria
chemical_list: D019380:Anti-HIV Agents; D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D019829:Nevirapine