Lopinavir/ritonavir versus Efavirenz-based Antiretroviral Treatment for the Prevention of Malaria among HIV-infected Pregnant Women. HIV-infected pregnant women are at increased risk of malaria and its complications. In vitro and in vivo data suggest that the HIV protease inhibitor lopinavir/ritonavir may have potent anti-malarial activity. We sought to evaluate whether lopinavir/ritonavir-based antiretroviral therapy (ART) reduced the risk of placental malaria. HIV-infected, ART-naïve pregnant women were enrolled between 12-28 weeks gestation and randomized to lopinavir/ritonavir or efavirenz-based ART. Women received daily trimethoprim-sulfamethoxazole prophylaxis and insecticide-treated bednets at enrollment and were followed up to 1 year postpartum. Primary outcome was placental malaria defined by the detection of malaria parasites using microscopy or PCR from placental blood. Secondary outcomes included placental malaria defined by histopathology, adverse birth outcomes, incidence of malaria, and prevalence of asymptomatic parasitemia. Analyses were done using an intention-to-treat approach.
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