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test the safety and efficacy of this new formulation in young children

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Bringing antiretroviral drugs to children

The CHAPAS trials have ensured that many more children with HIV have benefited
from life-saving antiretrovirals.

The challenge

There are growing concerns about the rise of non-communicable disease in Africa. Although lifestyle factors, such as diet, tobacco use and lack of exercise are important contributory factors, infectious diseases may also increase the risk of non-communicable diseases.

Even so, there is very little evidence from Africa on the impact of infectious diseases on non-communicable disease.

Professor Marielle Bouyou-Akotet has carried out extensive research on multiple aspects of malaria, and taken part in several influential international trials on antimalarial treatments. She also has research interests in other parasitic diseases affecting West Africa.

In her EDCTP Senior Fellowship, Professor Bouyou-Akotet is gathering more evidence on the contributions that intestinal parasitic diseases make to the risk of developing cardiometabolic disease. In the first phase of her project, she is enrolling adults aged 18–49 years at four sites – two urban (Libreville and Melen) and two rural (Koulamoutou and Bitam) locations – in Gabon. A questionnaire will be used to gather information on demographics and lifestyle risk factors, and biometric data on height, weight, blood pressure and other variables will be collected. Participants will be screened for multiple parasitic diseases, and laboratory tests will be used to identify metabolic and inflammatory abnormalities. A 10-year cardiovascular risk score will be calculated for each participant.

In phase 2 of the project, participants with and without parasite infections will be followed for 18 months and monitored for any cardiometabolic event or risk factor. Statistical analyses will then be used to determine whether the presence of a parasitic infection affects the risk of cardiometabolic disease.  

The project

The later CHAPAS-3 trial compared the efficacy and safety of three fixed-dose combinations including two without stavudine (found to have some long-term side effects in adults, leading to a recommendation that its use be discontinued in children). The trial the first of its kind in Africa studied nearly 500 children at four sites in two African countries.

Professor Bouyou-Akotet’s Senior Fellowship project will provide insight into the prevalence of cardiometabolic disease risk factors in urban and rural populations in a Central African country. It will also reveal whether intestinal parasites, including important neglected tropical diseases, affect the risk of cardiometabolic disease in either traditional rural or more westernised urban settings. The study will add to the evidence base on the burden of parasitic diseases in sub-Saharan Africa, including their contributions to non-communicable diseases.

ratios forfixed-dose combinations and on appropriatedosage according to weight. 

The CHAPAS-3 trial confirmed the effectiveness of fixed-dose combinations, providing further impetus to the rollout of antiretrovirals to children. Its evidence on abacavir informed the WHO recommendation of abacavir-containing combinations for first-line therapy in children. Trial data have also been used to support applications for regulatory approval for new scored efavirenz tablets.

Impact