Safety and efficacy of dihydroartemisinin–piperaquine for intermittent preventive treatment of malaria in pregnant women with HIV from Gabon and Mozambique: a randomised, double-blind, placebo-controlled trial

Chemoprevention for malaria with monthly intermittent preventive treatment with dihydroartemisinin–piperaquine in pregnant women living with HIV on daily co-trimoxazole in Kenya and Malawi: a randomised, double-blind, placebo-controlled trial

“…The reduction in malaria incidence is similar to that reported by González and colleagues in the near-identical trial done in Mozambique and Gabon. 14 These results, however, are a marked contrast with the previous pilot study in 200 pregnant women with HIV on cART consisting of efavirenz, tenofovir, and lamivudine in Uganda. 8 The study showed that monthly IPTp with dihydroartemisinin–piperaquine did not reduce the risk of placental or maternal malaria because of the clinically significant drug–drug interaction with efavirenz, resulting in a 27% lower area under the concentration (AUC; hours 0–8) time curve for dihydroartemisinin and 38% lower piperaquine AUC levels (days 0–21) than those in pregnant women without HIV and not on cART participating in a previous trial.…”

“… 25 The absence of an effect on adverse pregnancy outcomes, despite major reductions in malaria infections, is consistent with the two previous IPTp trials with mefloquine in women living with HIV, 4 , 5 , 17 and with the recent trial by González and colleagues that also assessed adding monthly IPTp with dihydroartemisinin–piperaquine to daily co-trimoxazole in women living with HIV. 14 Malaria is one of the many contributors to low birthweight and preterm delivery. In our study, only 15% of participants in the co-trimoxazole plus placebo group had a malaria infection at least once after enrolment, and one-third of these infections were below the detection level by microscopy.…”