Impact of HIV-Associated Immunosuppression on Malaria Infection and Disease in Malawi

• Published in: The Journal of infectious diseases Vol. 193; no. 6; pp. 872 - 878
• Main Authors: Laufer, Miriam K., van Oosterhout, Joep J. G., Thesing, Philip C., Thumba, Feston, Zijlstra, Eduard E., Graham, Stephen M., Taylor, Terrie E., Plowe, Christopher V.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15-03-2006; University of Chicago Press; Oxford University Press
• Subjects: Adolescent; Adult; AIDS; Animals; Biological and medical sciences; Cohort Studies; Diseases; Fever; Fundamental and applied biological sciences. Psychology; HIV; HIV infections; HIV Infections - complications; HIV Infections - immunology; HIV Infections - virology; HIV Seropositivity; HIV-1 - isolation & purification; HIV/AIDS; Human immunodeficiency virus; Human protozoal diseases; Human viral diseases; Humans; Immunosuppression; Infections; Infectious diseases; Longitudinal Studies; Malaria; Malaria - complications; Malaria - epidemiology; Malaria - immunology; Malawi - epidemiology; Medical sciences; Microbiology; Middle Aged; Mycobacterium; Parasitemia; Parasites; Parasitic diseases; Plasmodium falciparum - isolation & purification; Protozoal diseases; Tuberculosis; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Malawi; Africa; Infection; Immunopathology; Protozoal disease; Immunosuppression; Microbiology; Malaria; Viral disease; AIDS; Parasitosis; Immune deficiency
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/500245

BackgroundHuman immunodeficiency virus (HIV) infection and malaria coexist in much of Africa. Previous studies differ in their findings on the interactions between the 2 infections MethodsAdults living with HIV infection in Blantyre, Malawi, were enrolled in a longitudinal observational study from September 2002 to August 2004. Malaria blood smears were obtained monthly and for any illness suggestive of malaria. Complete evaluations of all illness episodes were conducted, regardless of malaria smear results ResultsThe incidence of clinical malaria episodes was higher in participants with CD4 cell counts <200 cells/mm3 than in those with CD4 cell counts >500 cells/mm3. The trend was preserved when increasingly specific definitions of malaria disease were used. The prevalence of malaria infection was not associated with CD4 cell count. In per-visit analysis, lower CD4 cell counts were associated with higher incidences of pneumonia, sepsis, and tuberculosis but not of malaria. Severe malaria was rare, with only 3 cases in 591 person-years of observation. Parasite density and CD4 cell count were independent risk factors for fever ConclusionsProfoundly immunosuppressed adults with HIV infection require more-frequent treatment for uncomplicated malaria, but malaria infection and disease are less strongly associated with HIV-associated immunosuppression than are other opportunistic infections. Where malaria is common, the high incidence of fever found among immunosuppressed adults may lead to misclassification of illness episodes as malaria