Malaria Drugs – HIV Drugs: Interactions?

hiv-malaria-interactions.jpgMalaria and HIV overlap in much of Africa. In 2004 WHO held discussions about potential interactions between HIV and malaria. At that time the technical group found there was need for more research to determine if there were any interactions of any magnitude between HIV drugs and artemether, lumefantrine or quinine.

Two recent reports address HIV and Malaria drug interactions. German et al. published a brief correspondence entitled, “Hepatotoxicity Due to a Drug Interaction between Amodiaquine (AQ) plus Artesunate and Efavirenz.” Parikh et al. have also suggested potential problems. “Considering drugs likely to be coadministered with AQ, the antiretroviral drugs efavirenz, saquinavir, lopinavir, and tipranavir (could inhibit AQ metabolism and) may have important clinical implications for the efficacy and toxicity of AQ.” Meanwhile, Kokwaro and colleagues indicate that the jury is still out on interactions between artemether-lumefantrine and antiretrovirals.

Bretlinger et al. express concern that “Standard clinical guidelines do not reflect the full complexity of the interactions and overlaps between the 2 infections” because of their “vertical” nature. Now that more is becoming known about HIV-Malaria interactions generally and drug interactions specifically, the time for integrated disease management guidelines is upon us. WHO and partners like GFATM, US Government (PMI, PEPFAR) and World Bank, among others need to come together and develop an integrated approach to researching, funding and fighting these two diseases.

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