How reducing malaria in pregnant women living with HIV
The conclusive findings from the MAMAH clinical trial, funded by the European & Developing Countries Clinical Trials Partnership (EDCTP) and orchestrated by the Barcelona Institute for Global Health (ISGlobal), highlight the efficacy of preventive treatment with dihydroartemisinin and piperaquine (DHA-PPQ) in averting malaria during pregnancy among women living with HIV. Published in the Lancet Infectious Diseases, this breakthrough offers a promising solution for the approximately one million pregnant women annually grappling with the dual burden of malaria and HIV. Pregnant women, especially in malaria-endemic regions, are susceptible to infection, leading to the recommendation of sulphadoxine and pyrimethamine (SP) for preventive treatment. However, the incompatibility of SP with co-trimoxazole (CTX), an antibiotic crucial for HIV-positive individuals, leaves pregnant women with HIV inadequately shielded.
Raquel González, an ISGlobal researcher and technical coordinator of the MAMAH project led by Clara Menéndez, Director of ISGlobal's Maternal, Child and Reproductive Health Initiative, emphasizes the vulnerability of pregnant women with HIV. Despite being at the highest risk of malaria infection and its repercussions, this population remains the least protected due to the compatibility issues between SP and CTX.
The primary objective of the MAMAH project was to assess the safety and effectiveness of alternative drugs, specifically dihydroartemisinin and piperaquine (DHA-PPQ), in preventing malaria during pregnancy among women living with HIV. The clinical trial unfolded in Gabon and Mozambique, enrolling over 600 pregnant women who were concurrently receiving CTX and antiretroviral treatment for HIV. The participants were divided into two groups: one administered DHA-PPQ, and the other received a placebo.
While there was no substantial variance in malaria infection rates at the time of delivery, the DHA-PPQ group exhibited a significantly diminished risk of developing clinical malaria throughout pregnancy—nearly eight times lower than the placebo group. Additionally, the risk of infection was nearly halved in the DHA-PPQ group. Encouragingly, DHA-PPQ proved effective across various antiretroviral treatments. The administration of DHA-PPQ did not result in any serious side effects, and notably, it had no impact on the transmission of HIV from mother to child.
These groundbreaking results underscore the potential of DHA-PPQ as a viable and safe preventive strategy for pregnant women living with HIV in malaria-endemic areas. The study not only addresses the pressing health concerns of this vulnerable population but also provides a crucial alternative to the incompatible SP, thereby bridging the gap in protection. The significance of this research extends beyond individual health outcomes, as it has the potential to positively impact the well-being of countless pregnant women facing the dual burden of malaria and HIV globally.
In conclusion, the MAMAH clinical trial's conclusive findings position DHA-PPQ as a beacon of hope in the realm of preventive strategies for pregnant women living with HIV. By addressing the compatibility challenges associated with existing treatments, this breakthrough offers a pathway to enhanced protection against malaria during pregnancy, ultimately contributing to the overall health and well-being of this high-risk population.
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