Protecting the most vulnerable: The urgent need to include HIV-exposed children in malaria chemoprevention strategies

Who are the children most vulnerable to malaria?The burden of malaria and HIV infection overlap in sub-Saharan Africa, where it is estimated that 94% of malaria cases and 95% of malaria-related deaths occurred in 2022 [1].The 2 diseases also share social and biological determinants of risk, being children one of the most susceptible populations to severe malaria [2].SummaryAU : Pleaseconfirmthatallheadinglevelsarerepresentedcorrectly: points• Perennial malaria chemoprevention (PMC) is recommended for children living in high transmission malaria endemic countries.• Sulfadoxine-pyrimethamine (SP), the first drug used for PMC, is contraindicated in individuals receiving a sulfa-based medication, including cotrimoxazole (CTX), due to possible sulfonamide-induced adverse drug reactions.• Despite HIV-exposed children having a higher risk of severe malaria than HIV-unexposed children, they are not eligible to receive PMC with SP because they are usually on daily CTX prophylaxis.• Thus, the most vulnerable children to malaria are currently the least protected by malaria chemoprevention strategies.• Lessons learnt from malaria prevention in HIV-positive pregnant women show the need to evaluate alternative antimalarial drugs for PMC than can be safely administered to HIV-exposed children on CTX prophylaxis.