HIVI infection is associated with increased malaria and parasitaemia

Bastos, Francisco Inácio MD, PhD

Oswaldo Cruz Foundation, Rio de Janeiro, Brazil

Abstracted from:Whitworth J, Morgan D, Quigley M, Smith A, Mayanja B, Eotu H, Omoding N, Okongo M, Malamba S, Ojwiya A. Effect of HIV-I and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study. Lancet 2000; 356: 1051-1056 .

Evidence-based Healthcare 5(2):p 39, June 2001.

BACKGROUND

Links between HIV1 and malaria have been proposed but not practically demonstrated. In sub-Saharan Africa, 22 million people are infected with HIV and 500 million per year acquire malaria.

OBJECTIVE

To investigate the effects of HIV1 infection and associated increases in immunosuppression on clinical malaria and falciparum parasitaemia.

SETTING

Rural Uganda; 1990-1998.

METHOD

Prospective cohort study.

LITERATURE REVIEW

No explicit strategy; 27 references.

PARTICIPANTS

Four hundred and eighty-four HIV1 positive and negative adults.

INTERVENTION

Participants were invited to attend clinics routinely every 3 months and whenever they were sick. Malaria information was collected at each visit.

OUTCOMES

Rates of clinical malaria; malarial parasitaemia; CD4-cell counts (immunosuppression indicator).

MAIN RESULTS

HIV1 positive participants had more sickness-related visits; higher rates of malarial parasitaemia (12 versus 6%, P<0.0001); and clinical malaria (2 versus 0.7% for routine visits, P=0.0003; 4 versuss 2% for interim visits, P = 0.009). They were twice as likely to suffer from malaria. Higher parasite densities and risk of clinical malaria were associated with lower CD4-cell counts.

AUTHORS' CONCLUSIONS

HIV1 is associated with increased malaria and parasitaemia, especially as immunosuppression advances.