African women living with HIV have an effective option to prevent malaria during pregnancy, clinical trial finds

In women living with HIV, preventive treatment with DHA-PPQ is a safe and effective strategy to prevent malaria during pregnancy, according to final results from MAMAH, a clinical trial coordinated by the Barcelona Institute for Global Health (ISGlobal). The study, published in the Lancet Infectious Diseasescould help protect the health of the million pregnant women who suffer from double infection with malaria and HIV each year.

Pregnant women are particularly vulnerable to malaria infection. Hence the recommendation to offer preventive treatment (IPTp) based on sulfadoxine and pyrimethamine (SP) to pregnant women living in malaria endemic areas. The problem is that these drugs are incompatible with cotrimoxazole (CTX), an antibiotic given to people with HIV to prevent bacterial infections.

“This means that the population most vulnerable to malaria infection and its consequences, namely pregnant women living with HIV, is also the least protected,” explains Raquel González, researcher at ISGlobal, technical coordinator of the project MAMAH, led by Clara Menéndez, director of the ISGlobal project. Maternal, Child and Reproductive Health Initiative.

The aim of the project was to evaluate the safety and effectiveness of two other drugs: dihydroartemisinin and piperaquine (DHA-PPQ) to prevent malaria during pregnancy in women living with HIV. The research team conducted the trial in Gabon and Mozambique with more than 600 pregnant women taking CTX in addition to antiretroviral treatment for HIV. One group of pregnant women received DHA-PPQ and the other group received a placebo.

Lower risk of infection and malaria disease

Although there was no significant difference in malaria infection at the time of delivery, women in the DHA-PPQ group had a significantly lower risk of developing clinical malaria throughout pregnancy. (nearly eight times lower than that of the placebo group) and also a lower risk (almost eight times lower than that of the placebo group). half) to be infected. DHA-PPQ has been shown to be effective in women taking different antiretroviral treatments. No serious side effects were observed and DHA-PPQ had no effect on mother-to-child transmission of HIV.

“We show that preventive treatment with DHA-PPQ is effective even in settings of low malaria transmission,” says Gonzalez. “Adding this strategy to the tools to fight malaria could significantly improve the health of thousands of mothers and their babies, particularly in sub-Saharan Africa, a region where an estimated one million women living with HIV are infected with malaria every year during their pregnancy,” she said. adds.

“We congratulate the MAMAH team for these important results in the field of malaria research and, in particular, for improving the health of pregnant women living with HIV in malaria-endemic areas,” said Montserrat Blázquez-Domingo, Senior Project Manager at EDCTP.

“This study highlights the value of collaborative research supported by EDCTP and our focus on priority infectious diseases affecting sub-Saharan Africa in populations often excluded from clinical trials, such as pregnant women.”