Efficacy of artemisinin-based combination therapy (ACT) in people living with HIV (PLHIV) diagnosed with uncomplicated Plasmodium falciparum malaria in Africa: a WWARN systematic review

Takyi, Abena; Soma, Aboubakar; Przybylska, Marianna; Harriss, Eli; Barnes, Karen I.; Dahal, Prabin; Guérin, Philippe J.; Stepniewska, Kasia; Carrara, Verena I.

doi:10.1186/s12936-025-05393-8

Table 2 Comparison of anti-malarial treatment efficacy between PLHIV and HIV-uninfected malaria patients

From: Efficacy of artemisinin-based combination therapy (ACT) in people living with HIV (PLHIV) diagnosed with uncomplicated Plasmodium falciparum malaria in Africa: a WWARN systematic review

Study ID	Malaria drug	HIV drug	N: HIV-	Event HIV-	N: HIV +	Event HIV +	Day	Statistics	Type of analysis	Comparison HIV (−) to HIV (+) Estimate	95%CI	P-value
Recrudescence
3	ASAQ	TS, ART^a	250	9^b	34	0	28	HR^c	Univariable	N/A		0.25
11	AL	EVF + LPV/r + NVP	181	5^d	181	6^d	28	OR^e	Univariable	0.83	0.20–3.33	1
12	AL or SP	None	530	61	266	37	45	RR	Multivariable controlled for treatment	0.85	0.58–1.23	0.38
Recurrence
3	ASAQ	TS, ART	250	33	34	1	28	HR²	Univariable	1.75		0.08
5	DP	TS, NVP^f	705	N/A	276	N/A	42	HR	Univariable	1.75		0.001
5	AL	TS, NVP^f	699	N/A	333	N/A	42	HR	Univariable	1.51		0.002
11	AL	EFV	181	88	50	19	28	OR	Multivariable controlled for day 7 lumefantrine concentration	2.84	1.04–7.78	0.04
	AL	EFV	181	88	50	19	28	OR	Multivariable	1.73	0.73–4.11	0.21
	AL	EFV	181	88	50	19	28	OR	Univariable	1.87	0.86–4.06	0.11
15	AL	EFV	30	4	9	3	42	OR	Univariable	0.31	0.05–1.75	0.319
11	AL	LPV/r	181	88	70	10	28	OR	Multivariable controlled for day 7 lumefantrine concentration	5.03	1.58–15.98	0.006
	AL	LPV/r	181	88	70	10	28	OR	Multivariable	6.48	2.18–19.21	0.0008
	AL	LPV/r	181	88	70	10	28	OR	Univariable	6.32	2.23–17.95	0.0005
	AL	NVP	181	88	61	19	28	OR	Multivariable controlled for day 7 lumefantrine concentration	2.22	1.10–4.48	0.03
	AL	NVP	181	88	61	19	28	OR	Multivariable	2.27	1.12–4.60	0.02
	AL	NVP	181	88	61	19	28	OR	Univariable	2.36	1.21–4.58	0.01
19	AL	NVP (1 EFV)^g	99	12	68	12	28	OR	Univariable	0.64	0.27–1.53	0.317
12	AL or SP	None	530	86	266	49	45	RR	Multivariable controlled for treatment	0.89	0.65–1.22	0.45
6	AL	TS, ART^h	2371	774	533	128	28	HR^b	Univariable	1.55		NA
	DP	TS, ART^h	2176	153	484	29	28	HR^b	Univariable	1		NA
	AL	TS, ART^h	2371	N/A	533	N/A	42	HR^b	Univariable	1.9		NA
	DP	TS, ART^h	2176	N/A	484	N/A	42	HR^b	Univariable	1.18		NA
	AL	TS, ART^h	2371	N/A	533	N/A	84	HR^b	Univariable	2.02		NA
	DP	TS, ART^h	2176	N/A	484	N/A	84	HR^b	Univariable	2.07		NA
New infection
12	AL or SP	None	530	25	266	12	45	RR	Multivariable controlled for treatment	1.04	0.53–2.04	0.89

AL artemether-lumefantrine, ART antiretroviral therapy, ASAQ artesunate-amodiaquine, DP dihydroartemisinin-piperaquine, EFV efavirenz, HR hazard ratio, LPV/r lopinavir/ritonavir, N/A information not available, NVP nevirapine, SP sulfadoxine-pyrimethamine, TS trimethoprim-sulfamethoxazole prophylactic treatment, OR odds ratio, RR relative risk
^aChildren meeting WHO eligibility criteria received ART (Zidovudine)
^bCalculated from KM estimates, HR estimated using the formula by Klein et al. [19]. KM estimates either provided in text or extracted from the figure
^cCould not be calculated as no recurrences were observed in the PLHIV group
^dBased on genotyping results for 96% of recurrences, assuming recurrences with missing PCR were reinfections
^eCalculated from raw numbers provided in the article, assuming 4% of recurrences with missing PCR were reinfections
^fIncludes PLHIV and patients exposed to HIV (DP: 71 infected, 64 on NVP; AL: 101 infected, 94 on NVP)
^gAll PLHIV were identified through attendance at a weekly clinic in which all received NVP (except for a single patient on efavirenz; when this patient was excluded from the analysis, the relationship between NVP use and lumefantrine concentration on day 7 remained significant)
^hTS includes also patients exposed to HIV who were randomly assigned to TS

Back to article page

ISSN: 1475-2875

Contact us

Submission enquiries: journalsubmissions@springernature.com

Malaria Journal

Contact us