[Project summary in Français / Português]
Scientific title: Interactions between the antimalarial combination artemether/lumefantrine and antiretroviral therapy including nevirapine or lopinavir/ritonavir in HIV-infected adults
Our results have shown that the drug exposure for the antimalarial lumefantrine was increased slightly by the first-line antiretroviral nevirapine, and was increased substantially (up to 10-fold) by the second-line antiretroviral, lopinavir/ritonavir.
This interaction could enhance the efficacy of the malaria treatment, and our small study did not identify any harms caused by the use of these malaria and HIV treatments together in people living with HIV.
This work has motivated for a partnership with the WorldWide Antimalarial Resistance Network (WWARN) to conduct a pooled analysis of individual patient pharmacokinetic-pharmacodynamic and safety data from ACT Consortium as well as non-ACT consortium studies on artemether-lumefantrine interactions with widely used antiretrovirals.
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Several African countries are heavily affected by both HIV/AIDS and malaria. The World Health Organization and ministries of health in most endemic countries recommend the use of artemisinin-based combination therapy (ACT) for malaria and antiretroviral combination treatments (ART) for HIV/AIDS, and such treatments have become increasingly available.
The interactions that can happen in the body between HIV and malaria drugs are potentially clinically significant, but this has not been adequately defined in people living with HIV.
We have conducted a series of studies to understand and inform what appropriate dosage of ACT drugs is needed to treat malaria in patients who are already taking HIV medication (antiretrovirals). The research analyses pharmacokinetic drug interactions, meaning the changes to malaria or HIV drug concentrations in the bodies of patients who are taking more than one type of medication. We also assessed the safety of drugs to identify any potential harms of these combinations.
The study was conducted in two phases. The first looked at the interaction between first-line HIV and malaria drugs in patients infected with HIV: one group already taking the most widely used first-line antiretroviral drug combination, and the other group not taking any antiretrovirals. The second phase compared drug interactions of the same first line ACT, with the most widely used second-line antiretroviral drugs.
Elin Svensson, Jan-Stefan van der Walt, Karen I. Barnes, Karen Cohen, Tamara Kredo, Alwin Huitema, Jean B. Nachega, Mats O. Karlsson & Paolo Denti | Published
British Journal of Clinical Pharmocology
T. Kredo, K. Mauff, J. S. Van der Walt, L. Wiesner, G. Maartens, K. Cohen, P. Smith, and K. I. Barnes | Published
Antimicrobial Agents and Chemotherapy
T. Kredo, K. Mauff, L. Workman, J. S. Van der Walt, L. Wiesner, P. J. Smith, G. Maartens, K. Cohen and K. I. Barnes | Published
BMC Infectious Diseases