Effects of malaria intermittent preventive treatment with dihydroartemisinin-piperaquine on antiretroviral drug concentrations in African pregnant women living with HIV

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Intermittent preventive treatment during pregnancy (IPTp) for malaria prevention with sulfadoxine-pyrimethamine is contraindicated in pregnant women living with HIV receiving cotrimoxazole prophylaxis. A recent clinical trial showed that dihydroartemisinin-piperaquine (DHA-PPQ) for IPTp is a safe and effective option for malaria prevention in this population. The present study evaluated the impact of monthly IPTp with DHA-PPQ on antiretroviral (ARV) drug concentrations in 105 participants recruited in the aforementioned trial in Mozambique and Gabon between January and November 2021. ARV serum concentrations from maternal venous and cord blood collected at the first antenatal care visit and at the end of pregnancy were measured by ultra-high-performance liquid chromatography-tandem mass spectrometry. At the end of pregnancy, median concentrations of dolutegravir were 835.1 ng/mL (248.1-1,687.6) in maternal and 1,204.2 ng/mL (456.4-1,883.3) in cord blood. For lamivudine (3TC), median concentrations were 108.3 ng/mL (28.8-246.1) in maternal and 186.5 ng/mL (81.9-427.6) in cord blood. No significant differences in ARV concentrations were found between the antimalarial treatment arm and the placebo arm. Furthermore, in multivariate exploratory analysis, no independent associations were found between ARV concentrations and participant characteristics. Our study found similar ARV concentrations in both treatment groups, suggesting that DHA-PPQ for monthly IPTp does not affect ARV concentrations in maternal and cord blood in women living with HIV.CLINICAL TRIALSThis study is registered with ClinicalTrials.gov as NCT03671109.

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