New drug to reduce malaria rates in pregnant women with HIV

Women with HIV will have access to a drug that has been found effective in preventing malaria during pregnancy.

The study was conducted by researchers from the Kenya Medical Research Institute (Kemri) and the findings published in the Lancet journal on Tuesday.

The research was done in partnership with scientists from the Liverpool School of Tropical Medicine (LSTM), the Kamuzu University of Health Sciences and the Malawi University of Science and Technology.

The researchers found that addition of the antimalarial drug dihydroartemisinin–piperaquine to daily co-trimoxazole substantially reduces the risk of malaria in pregnancy.

The World Health Organization recommends daily doses of the antibiotic co-trimoxazole to prevent malaria in pregnant women with HIV.

However, its efficacy in sub–Saharan Africa is threatened because malaria parasites are becoming increasingly resistant to the drug.

Researchers assessed whether the addition of monthly dihydroartemisinin–piperaquine to daily co-trimoxazole is more effective in preventing malaria than a monthly placebo plus daily co-trimoxazole in women living with HIV.

Some 904 women were enrolled into the trial and assigned randomly to each group.

The trial found that pregnant women who received the combination of monthly dihydroartemisinin–piperaquine to daily co-trimoxazole had 68 per cent less malaria during pregnancy than women who received the standard of care with daily co-trimoxazole alone.

“We celebrate these findings that propose additional arsenal against a disease that risks about 70 per cent of our population," Kemri acting director general Prof Elijah Songok said.

"Malaria in pregnancy can cause a host of serious health complications, including miscarriage, stillbirth, pre-term delivery and growth restriction of newborn babies, and co-infection with HIV increases doubles these risks,” Songok warned.

The study also involved investigators from the University of Copenhagen, Denmark, from the US Centres for Disease Control and Prevention (CDC).

It was funded through the European and Developing Countries Clinical Trials Partnership (EDCTP2) programme.

“We hope that these findings, along with a similar trial being conducted in Gabon and Mozambique, will inform the malaria prevention guidelines from the WHO and national health policies," Dr Simon Kariuki said.

Kariuki is the head of malaria programme at Kemri Centre for Global Health Research (CGHR).

Professor of tropical epidemiology at LSTM and the study lead Feiko ter Kuile, welcomed the research findings as promising.

Dr Hellen Barsosio, a clinical research scientist at Kemri’s CGHR and lead author on the paper published in the Lancet, said the study found the drug to be more tolerable.

“Not only did we find that adding dihydroartemisinin–piperaquine to co-trimoxazole was safe and prevented two out of every three malaria infections during pregnancy, it was also very well tolerated by pregnant women, which is very important when a drug is given for prevention," she said.

Barsosio said the study could lead to a much-needed policy change that could make a real difference in improving maternal and newborn health in Africa.

The study follows a series of trials coordinated by LSTM with collaborators like Kemri to explore alternative options to prevent malaria in pregnant women without HIV.

It found that out of several antimalarials, dihydroartemisinin–piperaquine was the only one tolerated well enough to be considered for malaria prevention.

Until now, no suitable alternative or additional preventative treatment has been identified for pregnant women with HIV.

The currently recommended treatment for malaria prevention in pregnant women with HIV, a daily dose of co-trimoxazole, is an antibiotic already prescribed to prevent opportunistic infections in HIV patients that also has antimalarial properties.

However, the high and growing resistance of the malaria parasite to drugs such as cotrimoxazole is threatening its effectiveness.

In 2017, WHO said daily unsupervised cotrimoxazole provided only partial protection against malaria for women with HIV in areas with high-grade resistance and highlighted the need for research of new strategies for malaria prevention in pregnancy.