title: Malaria in HIV-Infected Children Receiving HIV Protease-Inhibitor- Compared with Non-Nucleoside Reverse Transcriptase Inhibitor-Based Antiretroviral Therapy, IMPAACT P1068s, Substudy to P1060.
abstract: BACKGROUND
  HIV and malaria geographically overlap. HIV protease inhibitors kill malaria parasites in vitro and in vivo, but further evaluation in clinical studies is needed.
  
  
  METHODS
  Thirty-one children from Malawi aged 4-62 months were followed every 3 months and at intercurrent illness visits for ≤47 months (September 2009-December 2011). We compared malaria parasite carriage by blood smear microscopy (BS) and confirmed clinical malaria incidence (CCM, or positive BS with malaria symptoms) in children initiated on HIV antiretroviral therapy (ART) with zidovudine, lamivudine, and either nevirapine (NVP), a non-nucleoside reverse transcriptase inhibitor, or lopinavir-ritonavir (LPV-rtv), a protease inhibitor.
  
  
  RESULTS
  We found an association between increased time to recurrent positive BS, but not CCM, when anti-malarial treatment and LPV-rtv based ART were used concurrently and when accounting for a LPV-rtv and antimalarial treatment interaction (adjusted HR 0.39; 95% CI (0.17,0.89); p = 0.03).
  
  
  CONCLUSIONS
  LPV-rtv in combination with malaria treatment was associated with lower risk of recurrent positive BS, but not CCM, in HIV-infected children. Larger, randomized studies are needed to confirm these findings which may permit ART optimization for malaria-endemic settings.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT00719602.
authors.affiliation: Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States of America.|Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, NY, United States of America.|Batson Children's Hospital, Department of Pediatrics (Division of Infectious Diseases) and Department of Microbiology, University of Mississippi Medical Center, Jackson, MS, United States of America.
authors.forename: Charlotte V
authors.initials: CV
authors.lastname: Hobbs
authors.affiliation: Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Maryland, United States of America.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Gabriel
authors.affiliation: Kamuzu Central Hospital, University of North Carolina at Chapel Hill Lilongwe Project, Lilongwe, Malawi.
authors.forename: Portia
authors.initials: P
authors.lastname: Kamthunzi
authors.affiliation: Kamuzu Central Hospital, University of North Carolina at Chapel Hill Lilongwe Project, Lilongwe, Malawi.
authors.forename: Gerald
authors.initials: G
authors.lastname: Tegha
authors.affiliation: Kamuzu Central Hospital, University of North Carolina at Chapel Hill Lilongwe Project, Lilongwe, Malawi.
authors.forename: Jean
authors.initials: J
authors.lastname: Tauzie
authors.affiliation: Duke Clinical Research Institute, Durham, NC, United States of America.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Petzold
authors.affiliation: Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
authors.forename: Linda
authors.initials: L
authors.lastname: Barlow-Mosha
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.affiliation: Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, NY, United States of America.
authors.forename: Yonghua
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, NY, United States of America.|Cornell Clinical Trials Unit, Weill Cornell Medicine, NY, United States of America.
authors.forename: Tiina
authors.initials: T
authors.lastname: Ilmet
authors.affiliation: Department of Pediatrics, Division of Medical Genetics, University of Mississippi Medical Center, Batson Children's Hospital, Jackson, MS, United States of America.
authors.forename: Brian
authors.initials: B
authors.lastname: Kirmse
authors.affiliation: Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States of America.
authors.forename: Jillian
authors.initials: J
authors.lastname: Neal
authors.affiliation: Yale Schools of Public Health and Medicine, New Haven, Connecticut, United States of America.
authors.forename: Sunil
authors.initials: S
authors.lastname: Parikh
authors.affiliation: Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, NY, United States of America.
authors.forename: Nagamah
authors.initials: N
authors.lastname: Deygoo
authors.affiliation: HJF-DAIDS, a Division of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to NIAID, NIH, DHHS, Bethesda, MD, United States of America.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jean Philippe
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
authors.forename: Lynne
authors.initials: L
authors.lastname: Mofenson
authors.affiliation: HYDAS World Health, Inc., Hummelstown, PA, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Prescott
authors.affiliation: Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States of America.|Ben Towne Center for Childhood Cancer Research, Seattle Children's Research Institute, the University of Washington, and the Fred Hutchinson Cancer Research Center, Seattle WA, United States of America.
authors.forename: Jingyang
authors.initials: J
authors.lastname: Chen
authors.affiliation: Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.|Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda.
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
authors.affiliation: Division of Infectious Diseases and International Health, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America.
authors.forename: Paul
authors.initials: P
authors.lastname: Palumbo
authors.affiliation: Laboratory of Malaria Immunology and Vaccinology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, United States of America.
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Duffy
authors.affiliation: Department of Pediatrics, Division of Infectious Disease and Immunology, New York University School of Medicine, NY, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Borkowsky
mesh_terms: D000962:Antimalarials / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects / Q000201:enzymology / Q000254:growth & development; D006801:Humans; D007223:Infant; D019259:Lamivudine / Q000627:therapeutic use; D061466:Lopinavir / Q000627:therapeutic use; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000276:immunology / Q000469:parasitology; D008295:Malawi; D008297:Male; D019829:Nevirapine / Q000627:therapeutic use; D010963:Plasmodium falciparum / Q000187:drug effects / Q000254:growth & development; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D019438:Ritonavir / Q000627:therapeutic use; D019562:Viral Load / Q000187:drug effects; D015215:Zidovudine / Q000627:therapeutic use
chemical_list: D000962:Antimalarials; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D061466:Lopinavir; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; D019438:Ritonavir