Researchers Reduce Malaria Incidence in HIV-Positive Children by Providing Antibiotic, ITNs, Study Says

Researchers have managed to almost eliminate malaria incidence in a group of HIV-positive children by providing them with insecticide-treated nets and a daily dose of the low-cost antibiotic cotrimoxazole, according to a study presented on Tuesday at the 14th Conference on Retroviruses and Opportunistic Infections in Los Angeles, the San Francisco Chronicle reports. The discovery of the protective effect of antibiotics and ITNs could be significant in controlling malaria among children across Africa, regardless of their HIV status. For the study -- which was conducted in Kampala, Uganda -- researchers from Uganda and the San Francisco General Hospital provided 300 HIV-positive children ages one to 10 years with prophylactic doses of the antibiotic, as well as ITNs if the children were not using them already (Russell, San Francisco Chronicle, 2/28). The HIV-positive children involved in the study also received access to antiretroviral drugs, according to Anne Gasasira, an AIDS researcher at Makerere University in Kampala who led the study (Altman, New York Times, 3/1). The researchers compared the children's malaria incidence during an 11-month period with those of a group of 519 HIV-negative children, about 10% of whom used ITNs. All were offered ITNs during the course of the study. The researchers found that the antibiotic on its own reduced malaria cases by 35% in a group of children who did not start out sleeping under ITNs. Among the children who used ITNs alone, malaria cases decreased by 44%, and among children who took the antibiotic and used ITNs, malaria cases decreased by 97%. The study also found that 4% of the HIV-positive children who developed a fever were found to have malaria, according to Diane Havlir, director of the Positive Health Program at San Francisco General Hospital and a lead investigator of the study. In a region where doctors treat all fevers as malaria -- which could lead to an overuse of malaria drugs and result in drug resistance -- the findings indicate that children taking cotrimoxazole who develop a fever should be tested for malaria before prescribing malaria drugs. This method could lengthen the effectiveness of malaria drugs and reduce the risk of developing drug-resistant strains of the disease. Although the researchers believe the study could lead to a new malaria treatment strategy, Gasasira said that providing the antibiotic and ITNs to all children could be a "huge logistical problem." She added that all HIV-positive children "should be provided with these two relatively simple interventions" (San Francisco Chronicle, 2/28). Although the World Health Organization does not recommend the cotrimoxazole and ITN combination for malaria prevention, the agency does recommend them separately -- cotrimoxazole for HIV/AIDS-related infections and ITNs to prevent the spread of malaria in endemic areas. The data presented at the conference were measured as of August 2006, and the study is ongoing to determine if the findings will be similar during a longer period of time, according to the Times. Further studies also are planned (New York Times, 3/1).