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  • Dual HIV/malaria drug could prove a boon to Africa

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A drug designed to protect people with HIV/AIDS from dangerous bacterial infections could also protect them against malaria, say researchers.

Combining treatments in this way could be a major advantage in Africa, where many people have little or no access to malaria drugs.

The team says that although the drug, trimethoprim-sulfamethoxazole (TS), should not be used solely against malaria, it could save the lives of thousands of HIV-infected Africans — especially pregnant women — for whom malaria presents a huge health risk.

The researchers, led by Mahamadou Thera at the University of Bamako, Mali, published their findings online on 13 October in the Journal of Infectious Diseases.

The team looked at how well TS could prevent malaria in 245 children in Mali who did not have HIV/AIDS. Two-thirds of the children were given TS for 12 weeks, the other third nothing. Any children infected with malaria were treated with the widely used malaria drug sulfadoxine-pyrimethamine (SP).

The team showed that of the 157 children in the TS-treated group, only one developed malaria. But of the 77 children not taking TS, 72 got malaria.

The children given TS also had fewer gastrointestinal illnesses than the other group.

One of the researchers, Christopher Plowe at the US-based University of Maryland School of Medicine, told SciDev.Net that the team does not advocate using TS solely to prevent or treat malaria in Africa.

He explained this was because, in most countries, the rates of resistance to TS as well as to SP among malaria parasites are higher than they were in Mali at the time of the study.

Nor have the long-term risks of taking TS to prevent malaria been assessed.

But, Plowe said, the drug could help tackle malaria in people with HIV/AIDS. He added that pregnant HIV-infected women who are already taking TS "should probably not be given intermittent preventive therapy with SP", because the drugs work similarly against malaria, increasing the chance of side-effects.

Plowe added there had also been concerns about TS increasing parasite resistance to SP.

But, he says, the team's evidence for the effect of TS against malaria, as well as other research that shows it can stop HIV-infected people dying of severe bacterial infections, suggests that worries about resistance to SP should not prevent the widespread use of the cheap and widely available drug TS in those with HIV.

The World Health Organization is expected to release new guidelines for using TS in Africa soon.

Link to abstract of paper in the Journal of Infectious Diseases 

Reference: Journal of Infectious Diseases 192, 1823 (2005)

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