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7. Treatment of uncomplicated P. falciparum malaria

and are associated with increased treatment failure rates. At the current time there is
insufficient information to modify the general malaria treatment recommendations for
patients with HIV/AIDS.
Patients infected with HIV may be receiving other medications, such as cotrimoxazole
(trimethoprim plus sulfamethoxazole) as prophylaxis, for opportunistic infections
and/or antiretroviral medicines. There is limited information on drug interactions
between antiretroviral therapies with ACTs. In one study, treatment of uncomplicated
malaria with artesunate plus amodiaquine was highly effective in both HIV-infected
and HIV-uninfected children. Importantly, however, there was a significant 7–8-fold
increased risk of neutropenia 14 days after initiation of treatment among HIV-infected
children compared to uninfected children. About one fifth of the episodes in the HIV-
infected group were severe or life threatening. Among the HIV-infected children, the
risk of neutropenia was significantly higher among those on antiretroviral regimens
containing zidovudine. Hepatotoxicity has been documented when efavirenz was given
together with artesunate plus amodiaquine. Given this limited but worrying information,
treatment of malaria in HIV-infected patients receiving zidovudine or efavirenz should,
if possible, avoid amodiaquine-containing ACT regimens. Although HIV-infection and
cotrimoxazole may also depress neutophil counts, there is insufficient information on
the interaction of amodiaquine containing ACT regimens with cotrimoxazole or HIV
infection to make recommendations.

box 7.10

recommendations: treatment for HIV-infected patients with uncomplicated P. falciparum malaria
 patients with Hiv infection who develop malaria should receive prompt, effective antimalarial
treatment regimens as recommended in the relevant sections of these guidelines.
 treatment or intermittent preventive treatment with sulfadoxine-pyrimethamine should not
be given to Hiv-infected patients receiving cotrimoxazole (trimethoprim plus sulfamethoxazole)
prophylaxis.
 treatment in Hiv-infected patients on zidovudine or efavirenz should, if possible, avoid
amodiaquine-containing act regimens.

7.10.2 Severe malnutrition

Malaria and malnutrition frequently coexist. There are only a few studies of antimalarial
drug disposition in people with malnutrition, although many antimalarial drug efficacy
studies have been conducted in populations and settings where malnutrition was prevalent
(see Annex 3, Section A3.15.2).
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