A recent clinical trial coordinated by the Barcelona Institute for Global Health (ISGlobal) has found that preventive treatment with DHA-PPQ is a safe and effective strategy to prevent malaria during pregnancy in women living with HIV. The study, known as MAMAH, published in the Lancet Infectious Diseases, could have significant implications for the estimated one million pregnant women who suffer from a dual infection of malaria and HIV each year.
Pregnant women are particularly vulnerable to malaria infection, which is why the recommendation is to offer preventive treatment (IPTp) based on sulphadoxine and pyrimethamine (SP) to pregnant women in malaria-endemic areas. However, these drugs are incompatible with co-trimoxazole (CTX), an antibiotic given to individuals with HIV to prevent bacterial infections.
This poses a significant problem, as the population most at risk for malaria and its consequences—pregnant women with HIV—are also the least protected. Raquel González, ISGlobal researcher and technical coordinator of the MAMAH project, led by Clara Menéndez, director of ISGlobal’s Maternal, Child, and Reproductive Health Initiative, explains this dilemma.
The aim of the MAMAH project was to evaluate the safety and efficacy of two alternative drugs—dihydroartemisinin and piperaquine (DHA-PPQ)—to prevent malaria during pregnancy in women living with HIV. The research team conducted the trial in Gabon and Mozambique, involving over 600 pregnant women who were already taking CTX and antiretroviral treatment for HIV. One group of women received DHA-PPQ while the other group received a placebo. While there was no significant difference in malaria infection at the time of delivery, the DHA-PPQ group had a significantly lower risk of developing clinical malaria throughout pregnancy, almost eight times lower than the placebo group. Additionally, they had nearly half the risk of becoming infected. The efficacy of DHA-PPQ was found to be consistent across different antiretroviral treatments, and no serious side effects were observed. Furthermore, DHA-PPQ did not affect mother-to-child transmission of HIV.
According to González, the trial results demonstrate that preventive treatment with DHA-PPQ is effective even in areas with low malaria transmission rates. She suggests that adding this strategy to existing malaria control measures could significantly improve the health of thousands of mothers and their babies, particularly in sub-Saharan Africa, where approximately one million women living with HIV are infected with malaria during pregnancy annually.
Montserrat Blázquez-Domingo, the Senior Project Officer at the European & Developing Countries Clinical Trials Partnership (EDCTP), commended the MAMAH team on their significant contributions to malaria research and the betterment of health for pregnant women with HIV in malaria-endemic areas. The study highlights the value of collaborative research supported by EDCTP and the organization’s focus on priority infectious diseases in sub-Saharan Africa, including populations that are often excluded from clinical trials, such as pregnant women.
In conclusion, the MAMAH clinical trial has found that preventive treatment with DHA-PPQ is an effective strategy to prevent malaria during pregnancy in women living with HIV. The results of this study have the potential to improve the health outcomes of thousands of pregnant women and their babies, particularly in malaria-endemic regions of sub-Saharan Africa. The findings underscore the importance of collaborative research and inclusive clinical trials in addressing priority infectious diseases in vulnerable populations.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
