An open-label study done in Tororo, Uganda involving a cohort of HIV positive children ages 2 months to 5 years recently showed the efficacy of lopinavir–ritonavir, anti-HIV drugs, based treatment in preventing malaria recurrence.
170 HIV positive children of the area were randomly assigned lopinavir-ritonavir, nevirapine, or efavirenz depending on their age and followed for 366 days. All base anti-retroviral treatments (ARTs) were given routinely with two accompanying nucleoside reverse transcriptase inhibitors (NRTIs).
Antiretroviral protease inhibitors such as lopinavir show anti-plasmodium falciparum, the most common malaria parasite, activity caused by the arresting of plasmodial aspartic proteases, which are similar to HIV proteases. This gives the link between potent anti-HIV drugs such as lopinavir and anti-malarial activity.
Results of the study showed significantly lower rates of recurrence of malaria in those receiving the lopinavir-ritonavir treatment vs. nevirapine/efavirenz treatment (1.32 vs. 2.25 episodes per person per year). This showed a 41% protective efficacy.
First episode risk, however, was no different between the two groups. Researchers hypothesized the lopinavir-ritonavir regimen slowed down the metabolism of lumefantrine, an anti-malarial given.
With the increasing availability of lopinavir-ritonavir, this treatment may be used more openly as an anti-malarial. This study suggests, more than anything, that controlling drug metabolism pharmaceutically can increase drug efficacy over time, which proves powerful in prophylaxis.
Jane Achan, Abel Kakuru, Gloria Ikilezi, Theodore Ruel, Tamara D. Clark, Christian Nsanzabana, Edwin Charlebois, Francesca Aweeka, Grant Dorsey, Philip J. Rosenthal, Diane Havlir, Moses R. Kamya. 2012. Antiretroviral Agents and Prevention of Malaria in HIV-Infected Ugandan Children. The New England Journal of Medicine.