The incidence of malaria was reduced by 41% among HIV-infected children who received lopinavir/ritonavir rather than nevirapine or efavirenz.
Antiretroviral protease inhibitors (PIs) show activity against Plasmodium falciparum in vitro, likely because of biochemical similarities between plasmodial and HIV proteases. To evaluate whether this activity translates into a reduced risk for childhood malaria, investigators randomized 176 HIV-infected children in Uganda (age range, 6 months to 5 years) to receive either lopinavir/ritonavir or a nonnucleoside reverse transcriptase inhibitor (NNRTI), each together with two nucleosides. Participants also received insecticide-treated bed nets, multivitamins, and daily cotrimoxazole prophylaxis. Those who developed uncomplicated malaria received artemether-lumefantrine.
During 162 person-years of follow-up, 285 new episodes of malaria occurred…