Malaria and HIV are two of the most common infections in sub-Saharan Africa. Malaria can worsen the clinical outcome for people with HIV, and is more common in HIV- infected adults. ART is linked with HIV virus suppression and decreased mortality in HIV-infected people. Previous studies have shown that preventive treatment with the antibiotic co-trimoxazole can reduce the incidence of malaria in people with HIV, and insecticide-treated bed nets are known to be effective in malaria prevention.
Jonathan Mermin (Centers for Disease Control and Prevention, Entebbe, Uganda) and colleagues assessed the combined effect of ART, co-trimoxazole, and insecticide-treated bed nets on the frequency of clinical malaria in around 1000 people with HIV in Uganda. The investigators introduced the interventions in phases. Phase 1 was no intervention, phase 2 was preventive treatment with co-trimoxazole, phase 3 was co-trimoxazole and ART, and phase 4 was co-trimoxazole, ART, and insecticide-treated bed nets. The researchers found the treatments had a cumulative protective effect on malaria incidence. Compared with no intervention, co-trimoxazole lowered malaria rate by 76%, ART and co-trimoxazole by 92%, and ART, co-trimoxazole, and insecticide-treated bed nets by 95%.
Dr Mermin states: "A combination of co-trimoxazole, antiretroviral therapy, and insecticide-treated bed nets substantially reduced the frequency of malaria in adults with HIV."
"ART probably reduced the frequency of malaria by improving immune function, rather than by direct antimalarial activity," he adds.