Increased severe anemia in HIV-1-exposed and HIV-1-positive infants and children during acute malaria

• Published in: AIDS (London) Vol. 20; no. 2; pp. 275 - 280
• Main Authors: OTIENO, Richard O, OUMA, Collins, ONG'ECHA, John M, KELLER, Christopher C, WERE, Tom, WAINDI, Eliud N, MICHAELS, Marian G, DAY, Richard D, VULULE, John M, PERKINS, Douglas J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 09-01-2006
• Subjects: Acute Disease; AIDS/HIV; Anemia - blood; Anemia - parasitology; Anemia - virology; Anemias. Hemoglobinopathies; Biological and medical sciences; Child, Preschool; Developing Countries; Diseases of red blood cells; Female; Hematocrit; Hematologic and hematopoietic diseases; Hemoglobins - analysis; HIV Infections - complications; HIV-1 - isolation & purification; Human immunodeficiency virus 1; Human protozoal diseases; Human viral diseases; Humans; Infant; Infectious diseases; Kenya; Malaria; Malaria, Falciparum - complications; Male; Medical sciences; Parasitemia - complications; Parasitic diseases; Plasmodium falciparum; Protozoal diseases; Rural Health - statistics & numerical data; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Kenya; Human; HIV-1; Immunopathology; Pediatrics; Protozoal disease; hematological complications; Malaria; HIV-1 virus; Anemia; Acute; Retroviridae; AIDS; Hemopathy; Parasitosis; Immune deficiency; Lentivirus; Infection; Virus; Viral disease; Complication; severe malarial anemia; Human immunodeficiency virus; Child; pediatric HIV
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/01.aids.0000200533.56490.b7

Since the primary hematological complication in both pediatric HIV-1 and malaria is anemia, co-infection with these pathogens may promote life-threatening severe malarial anemia (SMA). The primary objective of the study was to determine if HIV-1 exposure [HIV-1(exp)] and/or HIV-1 infection [HIV-1(+)] increased the prevalence of SMA in children with acute malaria.
The effect of HIV-1 exposure and HIV-1 infection on the prevalence of SMA (hemoglobin < 6.0 g/dl), parasitemia (parasites/microl), and high-density parasitemia (HDP, >or= 10 000 parasites/mul) was investigated in children <or= 2 years of age presenting at hospital with acute Plasmodium falciparum malaria in a rural holoendemic malaria transmission area of western Kenya.
Upon enrollment, a complete hematological and clinical evaluation was performed on all children. Malaria parasitemia was determined and children with acute P. falciparum malaria were evaluated for HIV-1 exposure and infection by two rapid serological antibody tests and HIV-1 DNA PCR, respectively.
Relative to HIV-1(-) group (n = 194), the HIV-1(exp) (n = 100) and HIV-1(+) (n = 23) groups had lower hemoglobin concentrations (P < 0.001 and P < 0.001, respectively), while parasitemia and HDP were equivalent between the three groups. Multivariate analyses demonstrated that the risk of SMA was elevated in HIV-1(exp) children (odds ratio, 2.17; 95% confidence interval, 1.25-3.78; P < 0.01) and HIV-1(+) children (odds ratio, 8.71; 95% confidence interval, 3.37-22.51; P < 0.0001). The multivariate model further revealed that HIV-1 exposure or infection were not significantly associated with HDP.
Results presented here demonstrate that both HIV-1 exposure and HIV-1 infection are associated with increased prevalence of SMA during acute P. falciparum infection, independent of parasite density.