Uganda: Triple Treatment Cuts Malaria in HIV Patients

The rate of malaria infections in people with HIV could be cut by up to 95 percent with a combination of antiretroviral drugs (ARVs), the antibiotic co-trimoxazole and insecticide-treated bed nets, new research shows.

Each of the three interventions alone is effective in fighting malaria in HIV patients, but when combined their impact is cumulative. Among 1,000 HIV-positive patients in Uganda, researchers found that co-trimoxazole reduced malaria incidence by 76 percent. Adding ARVs increased treatment efficacy to 92 percent, and it reached up to 95 percent when bed nets were included. ARVs may have had an indirect impact on malaria by strengthening patients' immune systems, said researchers.

Transmitted by mosquitoes, malaria kills more than a million people annually, mostly young children in Africa. However, HIV weakens a patient's immunity, making them more vulnerable to opportunistic infections like malaria. In HIV-positive adults and children, malaria is both more common and more severe.

"Our study was able to show that with the implementation of a few interventions the incidence of malaria can be dropped considerably," said Dr. Jonathan Mermin of the Uganda Virus Research Institute. "Although these interventions work separately, the prime message is that together they are associated with a 95 percent reduction in malaria," he said. "Malaria then becomes a rare event among this population whereas before the interventions it was quite common."

The full study, "Effect of Co-trimoxazole Prophylaxis, Antiretroviral Therapy, and Insecticide-Treated Bednets on the Frequency of Malaria in HIV-1-Infected Adults in Uganda: A Prospective Cohort Study," was published in The Lancet (2006;367:1256-1261).

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