The anti-malarial agent chloroquine has activity against HIV. The effect of chloroquine (n = 18) was compared to an anti-malarial agent without known anti-HIV-activity, sulfadoxine-pyrimethamine (n = 12), on breast milk HIV RNA levels among HIV-infected breastfeeding women in Zambia. After adjusting for CD4 count and plasma viral load, chloroquine was associated with a trend towards lower levels of HIV RNA in breast milk compared with sulfadoxine-pyrimethamine (P = 0.05). Higher breastmilk viral load was also observed among women receiving presumptive treatment for symptomatic malaria compared with asymptomatic controls and among controls reporting fever in the prior week. Further research is needed to determine the potential role of chloroquine in prevention of HIV transmission through breastfeeding.

The objective of the study was to compare the efficacies against uncomplicated falciparum malaria of chloroquine (CQ), amodiaquine (AQ), sulfadoxine-pyrimethamine (SP) and combinations of these inexpensive drugs. Medline, Embase, Cochrane CENTRAL Register of Controlled Trials, BIOSIS, Web of Science, African Index Medicus, DARE, Digital Dissertations and Current Controlled Trials were searched for randomised or quasi-randomised controlled trials conducted between 1991 and June 2004 regardless of language and geography. Malaria experts were consulted, reference lists were searched and individual authors were contacted for unreported study characteristics and additional data. Unpublished data were sought and included in the analyses. Thirteen randomised trials (n = 4248) were identified and the summary relative risks of treatment failure at 28 days were calculated. There was marginal benefit in adding CQ to SP, compared with SP monotherapy (RR = 0.74, 95% CI 0.54-1.02). Combining AQ with SP was associated with a significantly lower risk of treatment failure than SP monotherapy (RR = 0.35, 95% CI 0.15-0.82) and AQ monotherapy (RR = 0.59, 95% CI 0.42-0.83). AQ plus SP was associated with a significantly lower risk of treatment failure than CQ plus SP (RR = 0.42, 95% CI 0.25-0.72). Serious adverse events were rare and did not increase with combination therapy. It was concluded that amodiaquine plus SP remains an efficacious, affordable and safe option for treating malaria in certain settings.