Prophylactic treatment with DHA-PPQ was found to be a safe and effective strategy for preventing malaria during pregnancy in women living with HIV. This conclusion comes from the final results of MAMAH, a clinical study funded by the European & Developing Countries Clinical Trials Partnership (EDCTP) and coordinated by the Barcelona Institute for Global Health (ISGlobal), a foundation supported by „la Caixa“. The study, published in the Lancet Infectious Diseases, holds the potential to protect the health of an estimated one million pregnant women who suffer from co-infection with malaria and HIV each year.
Pregnant women are especially susceptible to malaria infection. Therefore, it is recommended to offer pregnant women living in malaria-endemic areas a preventative treatment (IPTp) based on Sulfadoxine and Pyrimethamine (SP). The problem is that these medications are not compatible with cotrimoxazole (CTX), an antibiotic administered 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, is also the least protected,“ explains ISGlobal researcher Raquel González, technical coordinator of the MAMAH project under the leadership of Clara Menéndez, Director of ISGlobal’s Mother, Child, and Reproductive Health Initiative.
The aim of the project was to evaluate the safety and efficacy of two additional drugs: Dihydroartemisinin and Piperaquin (DHA-PPQ) for the prevention of malaria during pregnancy in women with HIV. The research team conducted the study in Gabon and Mozambique with over 600 pregnant women taking CTX in addition to antiretroviral treatment for HIV. One group of pregnant women received DHA-PPQ and the other group received a placebo.
Reduced Risk of Malaria Infection and Illness
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 in the placebo group) and also a lower risk (almost half) of infection. DHA-PPQ was effective in women receiving various antiretroviral treatments. No serious side effects were observed, and DHA-PPQ had no impact on the mother-to-child transmission of HIV.
The study shows that prophylactic treatment with DHA-PPQ is also effective in low malaria transmission settings. „Augmenting 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,“
Raquel González, ISGlobal researcher
„We congratulate the MAMAH team on these important findings in the field of malaria research and particularly on improving the health of pregnant women living with HIV in malaria-endemic areas,“ says Montserrat Blázquez-Domingo, Senior Project Officer at EDCTP. „This study underscores the value of collaborative research supported by EDCTP and our focus on priority infectious diseases that affect populations in sub-Saharan Africa who are often excluded from clinical trials – such as pregnant women.“
The MAMAH study is part of the European Union-supported EDCTP2 program (Grant Number RIA2016MC-1613-MAMAH).
Barcelona Institute for Global Health (ISGlobal)
Laufer, MK, et al. (2024) Malaria prevention: Translating clinical trials into policy. The Lancet Infectious Diseases. doi.org/10.1016/S1473-3099(23)00808-3.