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London School of Hygiene & Tropical Medicine Malaria Centre

Malaria research in drug development, deployment and resistance

Treatment of asymptomatic malaria in HIVpositive and HIV-negative Nigerian adults using artemether-lumefantrine.

LSHTM investigators:
Ifeyinwa Chijioke-Nwauche, Mary Oguike, Albert van Wyck, Naiela Malik, Harparkash Kaur & Colin Sutherland.
External collaborators:
University of Port Harcourt, Nigeria.

The co-infection of malaria and HIV has become a major challenge to public health in developing countries.

The highly active anti-retroviral therapy (HAART) currently used for the treatment of HIV patients has improved the prognosis of the disease, reducing mortality due to HIV infection. However the administration of these drugs poses a great challenge due to the potential drug-drug interactions as a result of multiplicity of drugs involved especially in co-morbid situations with malaria.

Using HPLC we assessed the bioavailability of lumefantrine based on the concentration in the capillary blood  7 days following treatment and also the impact of concomitant nevirapine treatment in subjects positive for P. falciparum infection. In HIV-positive people, with and without PCR-positive parasitaemia, artemether-lumefantrine improved CD4+ counts by day 28. Day 7 peripheral blood levels of lumefantine were significantly higher in nevirapine-treated people; lumefantrine levels were also higher in parasite positive people (by PCR) than PCR negative, but this effect was weaker than the ARV effect.Nevirapine, a non-nucleoside reverse transcriptase inhibitor, is known to stimulate live P450 enzymes, and this activation may account for improved day 7 lumefantrine levels. We are investigating the impact of higher levels on parasitological outcomes.