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Malaria

malaria

Before travelling to certain developing countries, you should find out about the status of malaria there as you are at a higher risk of malaria infection if you are HIV positive.

HIV also makes malaria worse as there is a higher density of parasites in the blood and the symptoms last for longer than with negative people. A low CD4 count and high viral load increases these risks.

Malaria also increases HIV viral load which may affect long term health. However, it is not considered to be an opportunistic infection as it can affect people with HIV regardless of the state of the immune system and previous immunity (e.g. from childhood) can be retained.

The drugs used to prevent malaria (prophylaxis) can interact with anti-HIV medication and levels of both the anti-malaria drugs and the anti-HIV drugs can be affected.

For this reason you would be best to speak to your HIV doctor, another member of your HIV care team or the information service, i-base, to get accurate information on which prophylaxis would work best and at what dose with your current HIV medication.

Malaria can be a severe problem for pregnant women with HIV who are even more at risk of infection and co-infection can cause complications to the pregnancy and birth.

If you travel to an area with malaria try to avoid mosquito bites, often best achieved by sleeping under an insecticide-impregnated bed net. Alternatives include using mosquito repellents on skin or clothing or sleeping in a room with burning mosquito-repellent coils or tablets.

  1. Prevention
  2. Drug interactions
  3. Treatment

Prevention

Firstly, you should check the status of malaria in the country you are visiting. It's also important to know that antimalarial drugs depend on the destination.

As with non-HIV-infected travellers, the choice of antimalarial prophylaxis depends on the destination, and is currently recommended for all travellers to sub-Saharan Africa (excluding parts of South Africa), the Indian subcontinent, Southeast Asia, Central and South America, parts of Mexico, North Africa, Haiti, and the Dominican Republic.

Chloroquine, mefloquine, doxycycline, and the combination drug Malarone (atovaquone plus proguanil) are commonly used, with mefloquine the most frequently indicated prophylactic for travellers to areas where chloroquine-resistantmalaria is endemic.

Find out which drugs are recommended for individual countries.

Drug interactions

Some malaria medications can interact with your HIV medications.

The use of anti-malaria drug mefloquine and HIV medication ritonavir together has been shown in studies to reduce the level of ritonavir in the body.

Efavirenz, Kaletra and boosted atazanavir have been shown to reduce levels of the anti-malaria drug atovaquone/proguanil.

However you should generally stick with standard antimalarial recommendations, unless particular adverse effects (such as nausea, diarrhoea, other gastro-intestinal problems, strange dreams, dizziness, insomnia, headaches, or, less commonly, seizures) are interfering with HIV drug adherence.

Taking both your anti-malarial and anti-HIV drugs as instructed and on time is of particular importance.

Treatment

It's important to remember that malaria can be cured.

If you are infected with malaria, it can be treated with inexpensive drugs and can usually be cured.

The choice of drugs depends on whether the malaria in the region acquired has developed resistance to treatment.

Several anti-malarial drugs and combinations are available.

 

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The Information Standard: Certified member

This article was last reviewed on 31/5/2013 by T. Kelaart

Date due for the next review: 31/1/2014

Content Author: B. Smith

Current Owner: B. Smith

More information:

Guidelines for Malaria Prevention in Travellers from the United Kingdom, Health Protection Agency (2008)

Infection and Travel in Patients with HIV Disease, HIV InSite (2004)

Efavirenz, Kaletra and boosted atazanavir reduce levels of key anti-malaria drug, NAM aidsmap (2010)

Van Luin M et al. Lower atovaquone/proguanil concentrations in patients taking efavirenz, lopinavir/ritonavir or atazanavir/ritonavir. AIDS (online edition) DOI:10.1097/QAD.0b013e3283381929, 2010.