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The therapeutic efficacy of artemether-lumefantrine was evaluated in a cohort of PWH on antiretroviral therapy (ART) and included measurement of day 7 lumefantrine levels in a subset to evaluate for associations between lumefantrine exposure and treatment response.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Adults living with HIV (\u2265\u200918\u00a0years), on ART for\u2009\u2265\u20096\u00a0months with undetectable HIV RNA viral load and CD4 count\u2009\u2265\u2009250\/mm\n                      <jats:sup>3<\/jats:sup>\n                      were randomized to daily trimethoprim-sulfamethoxazole (TS), weekly chloroquine (CQ) or no prophylaxis. After diagnosis of uncomplicated\n                      <jats:italic>Plasmodium falciparum<\/jats:italic>\n                      malaria, a therapeutic efficacy monitoring was conducted with PCR-correction according to WHO guidelines. The plasma lumefantrine levels on day 7 in 100 episodes of uncomplicated malaria was measured. A frailty proportional hazards model with random effects models to account for clustering examined the relationship between participant characteristics and malaria treatment failure within 28\u00a0days. Pearson\u2019s Chi\u2014squared test was used to compare lumefantrine concentrations among patients with treatment failure and adequate clinical and parasitological response (ACPR).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>411 malaria episodes were observed among 186 participants over 5\u00a0years. The unadjusted ACPR rate was 81% (95% CI 77\u201386). However, after PCR correction to exclude new infections, ACPR rate was 94% (95% CI 92\u201397). Increasing age and living in Ndirande were associated with decreased hazard of treatment failure. In this population of adults with HIV on ART, 54% (51\/94) had levels below a previously defined optimal day 7 lumefantrine level of 200\u00a0ng\/ml. This occurred more commonly among participants who were receiving an efavirenz-based ART compared to other ART regimens (OR 5.09 [95% CI 1.52\u20137.9]). Participants who experienced treatment failure had lower day 7 median lumefantrine levels (91\u00a0ng\/ml [95% CI 48\u2013231]) than participants who experienced ACPR (190\u00a0ng\/ml [95% CI 101\u2013378], p-value\u2009&lt;\u20090.008).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Recurrent malaria infections are frequent in this population of PWH on ART. The PCR-adjusted efficacy of AL meets the WHO criteria for acceptable treatment efficacy. Nevertheless, lumefantrine levels tend to be low in this population, particularly in those on efavirenz-based regimens, with lower concentrations associated with more frequent malaria infections following treatment. These results highlight the importance of understanding drug-drug interactions when diseases commonly co-occur.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-023-04466-w","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T08:02:53Z","timestamp":1674806573000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Artemether-lumefantrine efficacy among adults on antiretroviral therapy in Malawi"],"prefix":"10.1186","volume":"22","author":[{"given":"Wongani","family":"Nyangulu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randy G.","family":"Mungwira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titus H.","family":"Divala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nginache","family":"Nampota-Nkomba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osward M.","family":"Nyirenda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea G.","family":"Buchwald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jernelle","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique E.","family":"Earland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher V.","family":"Plowe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrie E.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Mallewa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joep J.","family":"van Oosterhout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil","family":"Parikh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew B.","family":"Laurens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam K.","family":"Laufer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the TSCQ Study Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"key":"4466_CR1","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1093\/cid\/ciab252","volume":"73","author":"MB Laurens","year":"2021","unstructured":"Laurens MB, Mungwira RG, Nampota N, Nyirenda OM, Divala TH, Kanjala M, et al. 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