Concurrent management of malaria and HIV in pregnancy

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Challenges in the concurrent management of malaria and HIV in

pregnancy in sub-Saharan Africa

a E Brentlinger, B Behrens and Mark A Micek

The Lancet Infectious Diseases 2006; 6:100-111

DOI:10.1016/S1473-3099(06)70383-8

Summary

Approximately one million pregnancies are complicated by both

malaria and HIV infection in sub-Saharan Africa annually. Both

infections have been associated with maternal and infant morbidity

and mortality. Intermittent preventive treatment, usually with

sulfadoxine-pyrimethamine, has been shown to prevent pregnancy-

related malaria and its complications. Several different regimens of

antiretroviral therapy are now available to prevent mother-to-child

transmission of HIV and/or progression of maternal HIV infection

during pregnancy.

However, no published studies have yet shown whether standard

intermittent preventive treatment and antiretroviral regimens are

medically and operationally compatible in pregnancy. We reviewed

existing policies regarding prevention and treatment of HIV and

malaria in pregnancy, as well as published literature on adverse

effects of antiretrovirals and antimalarials commonly used in

pregnancy in developing countries, and found that concurrent

prescription of sulfadoxine-pyrimethamine, co-trimoxazole

(trimethoprim-sulfamethoxazole), and antiretroviral agents including

nevirapine and zidovudine per existing protocols for prevention of

malaria and vertical HIV transmission may result in adverse drug

interactions or overlapping, diagnostically challenging drug

toxicities.

Insecticide-treated bednets should be provided for HIV-infected

pregnant women at risk for malaria. Sulfadoxine-pyrimethamine should

be prescribed cautiously in women concurrently receiving daily

nevirapine and/or zidovudine, and should be avoided in women on

daily co-trimoxazole. Further research is urgently needed to define

safe and effective protocols for concurrent management of HIV and

malaria in pregnancy, and to define appropriate interventions for

different populations subject to differing levels of malaria

transmission and antimalarial drug resistance.

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