Before travelling to certain developing countries, you should find out whether malaria transmission occurs there as you’re at a higher risk of malaria infection if you’re HIV positive.
Avoid mosquito bites. This is often best achieved by sleeping under an insecticide-impregnated bed net. Alternatives include using mosquito repellents on skin or clothing or sleeping in a room with burning mosquito-repellent coils or tablets.
Do your research. Know whether malaria transmission occurs in the country you are visiting. The choice of antimalarial prophylaxis depends on the destination, and is currently recommended for all travellers to sub-Saharan Africa (excluding parts of South Africa), the Indian subcontinent, Southeast Asia, Central and South America, parts of Mexico, North Africa, Haiti, and the Dominican Republic.
Chloroquine, mefloquine, doxycycline, and the combination drug Malarone (atovaquone plus proguanil) are commonly used, with mefloquine the most frequently indicated prophylactic for travellers to areas where chloroquine-resistant malaria is endemic.
Find out which drugs are recommended for individual countries.
Some malaria medications can interact with your HIV medications.
The use of anti-malaria drug mefloquine together with HIV medication ritonavir isn't recommended.
Efavirenz, Kaletra and boosted atazanavir have been shown to reduce levels of the anti-malaria drug atovaquone/proguanil.
However you should generally stick with standard antimalarial recommendations, unless particular adverse effects (such as nausea, diarrhoea, other gastro-intestinal problems, strange dreams, dizziness, insomnia, headaches, or, less commonly, seizures) are interfering with HIV drug adherence.
Taking both your anti-malarial and anti-HIV drugs as instructed and on time is of particular importance.
HIV can make malaria worse as there’s a higher density of parasites in the blood and the symptoms last for longer than with negative people. A low CD4 count and high viral load both increase these risks.
Malaria also increases HIV viral load, which may affect long term health. However, it’s not considered to be an opportunistic infection as it can affect people with and without HIV; regardless of the state of the immune system and previous immunity (e.g. from childhood) can be retained.
It's important to remember that malaria can be cured.
If you get infected with malaria, it can be treated with inexpensive drugs and can usually be cured.
The choice of drugs depends on whether the malaria in the region of acquisition has developed resistance to treatment.
Several anti-malarial drugs and combinations are available.
Malaria can be a severe problem for pregnant women with HIV who are even more at risk of infection, and co-infection can cause complications to the pregnancy and birth.
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This article was last reviewed on
by Anna Peters
Date due for the next review: 13/12/2019
Content Author: B. Smith
Current Owner: Health Promotion
Guidelines for Malaria Prevention in Travellers from the United Kingdom, Health Protection Agency (2008)
Infection and Travel in Patients with HIV Disease, HIV InSite (2004)
Efavirenz, Kaletra and boosted atazanavir reduce levels of key anti-malaria drug, NAM aidsmap (2010)
Van Luin M et al. Lower atovaquone/proguanil concentrations in patients taking efavirenz, lopinavir/ritonavir or atazanavir/ritonavir. AIDS (online edition) DOI:10.1097/QAD.0b013e3283381929, 2010.
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