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  • PA-340 A systematic review of the efficacy of artemisinin-based combination therapy (ACT) in people living with HIV (PLHIV) diagnosed with uncomplicated Plasmodium falciparum malaria in Africa

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PA-340 A systematic review of the efficacy of artemisinin-based combination therapy (ACT) in people living with HIV (PLHIV) diagnosed with uncomplicated Plasmodium falciparum malaria in Africa
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  1. Abena Takyi1,2,
  2. Aboubakar Soma1,3,
  3. Marianna Przybylska4,
  4. Eli Harriss5,
  5. Verena Carrara1,
  6. Karen Barnes1,
  7. Prabin Dahal1,
  8. Philippe J Guérin1,
  9. Kasia Stepniewska1
  1. 1Infectious Diseases Data Observatory (IDDO), University of Oxford, UK
  2. 2Department of Child Health, Korle Bu Teaching Hospital, Ghana
  3. 3Centre MURAZ/National Institute of Public Health, Burkina Faso
  4. 4University of Edinburgh, UK
  5. 5Bodleian Health Care Libraries, University of Oxford, UK

Abstract

Background Africa bears the highest double-burden of HIV and malaria worldwide. In 2022, 25.6 million people were living with HIV (PLHIV) and 228 million malaria cases were diagnosed in Africa. Malaria patients co-infected with HIV are considered at a higher risk of failing malaria treatment according to the WHO. This review aims to assess the treatment outcomes following artemisinin combination therapies (ACTs) in PLHIV.

Methods The literature search was conducted up to April 2022 in the following databases: MEDLINE, EMBASE, Web of Science, Cochrane Central, WHO Global Index Medicus and Clinicaltrials.gov. Studies describing any malaria treatment outcomes or antimalarial drug exposure (area under the curve, concentration) in PLHIV treated for falciparum malaria infection were eligible for inclusion.

Results A total of 26 eligible articles were screened of which 19 studies (2003–2017) from six countries were included in this review; this represented >3,000 malaria episodes in PLHIV across various transmission settings. Antimalarial treatments studied were artemether-lumefantrine [AL] (n=16), dihydroartemisinin-piperaquine (n=7), and artesunate-amodiaquine (n=1); PLHIV were treated with efavirenz (EFV, n=11), nevirapine (NVP, n=9), atazanavir-ritonavir (n=1), trimethoprim-sulfamethoxazole (n=6), lopinavir/ritonavir (LPV/r, n=4), or were untreated (n=3). Compared with no HIV patients, EFV reduced exposure to all antimalarial components (n=2), LPV/r increased lumefantrine exposure (n=1); NVP reduced artemether exposure only (n=2). There was no evidence of increased risk of recrudescence in PLHIV compared to patients without HIV (n=7), but for AL, PLHIV receiving LPV/r appear to have a lower risk of recurrence when compared to no HIV (n=1), or PLHIV on NVP or EFV (n=2).

Conclusion Limited data on ACT treatment outcomes or drug exposure in PLHIV exist, and the effect of antivirals appears inconsistent in the literature. Considering the heterogeneity in study designs, our findings support conducting an individual patient data meta-analysis to explore the impact of ARVs on antimalarial treatment.

https://doi.org/10.1136/bmjgh-2023-EDC.165

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