Quinine exposure (after single dose) is reduced by approximately a third with nevirapine, although the clinical significance is uncertain.[18] A case report in a single patient observed increased P. falciparum parasitaemia in the presence of quinine in a patient taking nevirapine (attributed to CYP3A4 induction), and switching to atovaquone/proguanil was effective in treating the patient’s malaria.[19] Quinine concentrations were lower, and 3-hydroxyquinine higher, in 6 pregnant women with detectable nevirapine, compared to one patient without. This evidence concerns the gene CYP3A4 and malaria.