Exploring secure pathways: finding the most reliable malaria prophylaxis strategies for HIV-positive pregnant women

Abstract

Malaria in pregnant women, particularly those infected with HIV, poses significant health risks, including adverse maternal and neonatal outcomes. This perspective examines various prophylactic strategies, emphasizing recent clinical trial findings on the efficacy and safety of newer antimalarial drugs. Sulfadoxine-pyrimethamine (SP) has been a conventional choice for intermittent preventive treatment during pregnancy (IPTp). However, its effectiveness is compromised due to its interaction with cotrimoxazole (CTX), a medication frequently used for individuals with HIV. This interaction limits it’s utility. Recent research emphasizes the promise of dihydroartemisinin-piperaquine (DP) as an effective alternative, given its prolonged half-life and robust safety profile, including among HIV-infected pregnant women in regions with minimal malaria transmission. While DP did not notably lower the incidence of placental malaria, it effectively reduced the occurrence of clinical malaria and overall Plasmodium falciparum infections, indicating its potential to improve maternal health in endemic areas. Mefloquine (MQ), another alternative, though effective, is associated with severe side effects and increased HIV transmission risks, highlighting the need for cautious implementation. This narrative underscores the complexities of managing malaria prophylaxis in this vulnerable population, urging a tailored approach based on regional epidemiology and resistance patterns. The integration of these findings into health policies could significantly improve outcomes for mothers and newborns in sub-Saharan Africa, where malaria and HIV prevalently intersect. The ongoing adaptation of these interventions is critical to addressing the dynamic challenges of co-infections in pregnancy, ensuring effective and safe treatment pathways.