New study offers hope for reducing malaria in pregnant women living with HIV

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 of MAMAH, a clinical trial funded by the European & Developing Countries Clinical Trials Partnership (EDCTP) and coordinated by the Barcelona Institute for Global Health (ISGlobal), an institution supported by the “la Caixa” Foundation. The study, published in Lancet Infectious Diseasescould help protect the health of the estimated one million pregnant women who are dually infected with malaria and HIV each year.

Pregnant women are particularly vulnerable to malaria infection. Hence the recommendation to provide preventive therapy (IPTp) based on sulfadoxine and pyrimethamine (SP) to pregnant women living in malaria endemic areas. The problem is that these drugs are not compatible with co-trimoxazole (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, are also less protected,” explains ISGlobal researcher Raquel González, technical coordinator of the MAMAH program, led by Clara Menéndez, director of ISGlobal. Maternal, Child and Reproductive Health Initiative.

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

Lower risk of malaria infection and 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 during pregnancy (almost eight times lower than the placebo group) and also a lower risk of (almost half) of the infection. DHA-PPQ was effective in women receiving different antiretroviral therapies. 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 under conditions of low malaria transmission. Adding this strategy to malaria control tools could significantly improve the health of thousands of mothers and their babies, especially in sub-Saharan Africa, a region where an estimated one million women living with HIV become infected with malaria during pregnancy each year. time”.

Raquel González, ISGlobal researcher

“We congratulate the MAMAH team for these important results in the field of malaria research and, in particular, in providing better health to pregnant women living with HIV in malaria-endemic areas,” says Montserrat Blázquez-Domingo, EDCTP Senior Project Officer . “This study highlights the value of collaborative research supporting the EDCTP and our focus on priority infectious disease affecting sub-Saharan Africa in populations often excluded from clinical trials – such as pregnant women.”

The MAMAH study is part of the EDCTP2 Program supported by the European Union (grant number RIA2016MC-1613-MAMAH).