title: The epidemiological impact of HIV antiretroviral therapy on malaria in children.
abstract: OBJECTIVE
  The objective of this study is to determine the epidemiological effectiveness of a first-line antiretroviral regimen with HIV protease inhibitor for preventing recurrent malaria in children under the range of HIV prevalence levels and malaria transmission intensities encountered in sub-Saharan Africa.
  
  
  METHODS
  A dynamic model of malaria transmission was developed using clinical data on the protease inhibitor extended posttreatment prophylactic effect of the antimalarial treatment, artemether-lumefantrine, in addition to parameter estimates from the literature.
  
  
  METHODS
  To evaluate the benefits of HIV protease inhibitors on the health burden of recurrent malaria among children, we constructed a dynamic model of malaria transmission to both HIV-positive and HIV-negative children, parameterized by data from a recent clinical trial. The model was then evaluated under varying malaria transmission and HIV prevalence settings to determine the health benefits of HIV protease inhibitors in the context of artemether-lumefantrine treatment of malaria in children.
  
  
  RESULTS
  Comparing scenarios of low, intermediate and high newborn HIV prevalence, in a range of malaria transmission settings, our dynamic model predicts that artemether-lumefantrine with HIV protease inhibitor based regimens prevents 0.03-0.10, 5.2-13.0 and 25.5-65.8 annual incidences of malaria per 1000 children, respectively. In addition, HIV protease inhibitors save 0.002-0.006, 0.22-0.8, 1.04-4.3 disability-adjusted life-years per 1000 children annually. Considering only HIV-infected children, HIV protease inhibitors avert between 278 and 1043 annual incidences of malaria per 1000 children.
  
  
  CONCLUSIONS
  The use of HIV protease inhibitor based regimens as first-line antiretroviral therapy for HIV is an effective measure for reducing recurrent malaria among HIV-infected children in areas where HIV and malaria are coendemic, and artemether-lumefantrine is a first-line antimalarial.
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Greenhalgh
authors.forename: Martial
authors.initials: M
authors.lastname: Ndeffo
authors.forename: Alison P
authors.initials: AP
authors.lastname: Galvani
authors.forename: Sunil
authors.initials: S
authors.lastname: Parikh
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use*; D005449:Fluorenes / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D017320:HIV Protease Inhibitors