Researchers from Kenya Medical Research Institute (KEMRI) have published a study that shows a new drug has a good potential to prevent malaria in pregnant women living with human immunodeficiency virus (HIV).
The study, christened IMPROVE-2 by researchers from KEMRI in partnership with others from Liverpool School of Tropical Medicine (LSTM) in the UK, Malawi’s Kamuzu University of Health Sciences, and the Malawi University of Science and Technology, has been published in The Lancet. It suggests that adding the anti-malarial drug dihydroartemisinin–piperaquine to the daily dose of Co-trimoxazole substantially reduces the risk of malaria during pregnancy.
Until now, no suitable alternative or additional preventative treatment has been identified for pregnant women living with HIV. Co-trimoxazole, which also has anti-malarial properties, is an antibiotic that is prescribed to prevent opportunistic infections in people living with HIV.
Global health problem
This study follows a series of trials coordinated by LSTM with collaborators like KEMRI to explore alternative options to prevent malaria in pregnant women without HIV, which found that out of several anti-malarial medications, dihydroartemisinin–piperaquine was the only one tolerated well enough to be considered for malaria prevention.
“We celebrate these findings that propose an additional arsenal against a disease that puts about 70 percent of our population at risk. Malaria in pregnancy can cause a host of serious health complications, including miscarriage, stillbirth, pre-term delivery, and growth restriction of newborn babies, and co-infection with HIV increases doubles these risks,” said Prof Elijah Songok, the KEMRI chief executive.
Malaria is a major global health problem and, together with HIV and tuberculosis, is among the three most important global health problems in developing countries. Both of them, together, cause more than four million deaths per year.
Africa carries the highest burden of malaria
Co-infection exists in many parts of the world, especially in sub-Saharan Africa, where an estimated 25.6 million people are living with HIV, and more than 350 million episodes of malaria occur yearly.
Malaria and HIV infections are also the most deleterious conditions in sub-Saharan African pregnant women in terms of the morbidity and mortality they cause in mothers and their newborns.
According to the World Health Organization (WHO), there were about 247 million malaria cases globally in 2021. While the global percentage of people with malaria has remained constant over time, Africa carries the highest burden of this disease. It is important to note that the percentage of people living with malaria has been on a downward trend since 2000.
In 2017, WHO stated that daily unsupervised Co-trimoxazole provided only partial protection against malaria for women living with HIV in areas with high-grade resistance and highlighted the need for research of new strategies for malaria prevention during pregnancy.
Feiko ter Kuile, Professor of Tropical Epidemiology at LSTM and the study lead, said: “These are promising findings, and potentially welcome news in the future of prevention malaria among pregnant women living with HIV in areas where the prevalence of the disease is high. Our trial showed that the addition of dihydroartemisinin–piperaquine to the currently recommended preventative treatment strategy for pregnant women living with HIV reduced malaria by 68 percent.”
Much-needed policy change
Dr Hellen Barsosio, a Clinical Research Scientist from the KEMRI’s Centre for Global Health Research (CGHR) and lead author of the new study, said: “These findings are very encouraging. Not only did we find that adding dihydroartemisinin–piperaquine to Co-trimoxazole was safe and prevented two out of every three malaria infections during pregnancy, but it was also very well tolerated by pregnant women, which is important when a drug is given for prevention. The study could lead to a much-needed policy change that could make a real difference in improving African maternal and newborn health”.
Dr Simon Kariuki, Head of the Malaria Program from the KEMRI-CGHR, said: “We hope that these findings, along with similar trials being conducted in Gabon and Mozambique, will inform the malaria prevention guidelines from the WHO and national health policies.”
The study also involved investigators from the University of Copenhagen, Denmark, and the US Centers for Disease Control and Prevention (CDC) in Georgia. It was funded through the European and Developing Countries Clinical Trials Partnership (EDCTP2) program, a partnership between 15 European and 28 African countries.
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Clay Muganda is the Managing Editor, Alliance for Science Global South.