The potential for interactions between antimalarial and antiretroviral drugs

The rapid increase in access to antiretroviral therapy in developing countries has brought with it new challenges. These include the unprecedented need for lifelong treatment for an infectious disease and the pressure this will place on health services. The use of fixed dose combinations from generic manufacturers does not easily allow for individualization of dosage (e.g. with coadministered drugs for tuberculosis). Gaps in current knowledge that urgently need to be addressed are the effect of ethnicity gender and body weight upon antiretroviral drug disposition and defining interactions with other drugs including antimalarial and antituberculosis drugs and traditional medicines. Malaria is widespread across areas of the world where resources are limited and most of these areas also bear the brunt of the HIV pandemic. There are potentially many different ways in which both diseases interact at political social and public health levels as well as emerging evidence for how one disease may affect the pathogenesis and outcome of the other. At a time when access to antiretroviral drugs is increasing and new combinations of antimalarial drugs are being evaluated it is important that potential interactions between therapies for these two infections are also reviewed. (excerpt)