HIV infection increases the risk of acquiring Plasmodium vivax malaria: a 4-year cohort study in the Brazilian Amazon HIV and risk of vivax malaria

• Published in: Scientific reports Vol. 12; no. 1; p. 9076
• Main Authors: Guerra, Cecilia Victoria Caraballo, da Silva, Bernardo Maia, Müller, Pia, Baia-da-Silva, Djane Clarys, Moura, Marco Antônio Saboia, Araújo, José Deney Alves, Silva, Juan Carlo Santos e, Silva-Neto, Alexandre Vilhena, da Silva Balieiro, Antonio Alcirley, da Costa-Martins, André Guilherme, Melo, Gisely Cardoso, Val, Fernando, Bassat, Quique, Nakaya, Helder I., Martinez-Espinosa, Flor Ernestina, Lacerda, Marcus, Sampaio, Vanderson Souza, Monteiro, Wuelton
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 31-05-2022; Nature Publishing Group; Nature Portfolio
• Subjects: 692/699/255/1629; 692/699/255/1901; Brazil - epidemiology; CD4 antigen; Cohort analysis; Cohort Studies; Education; HIV; HIV Infections - complications; HIV Infections - epidemiology; HIV Seropositivity; Human immunodeficiency virus; Humanities and Social Sciences; Humans; Infections; Malaria; Malaria, Vivax - epidemiology; Male; Metropolitan areas; multidisciplinary; Parasitemia; Patients; Plasmodium falciparum; Recurrence; Risk factors; Science; Science (multidisciplinary); Sexually transmitted diseases; STD; Urban areas; Vector-borne diseases; Brazil; Amazon Basin
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-022-13256-4

Globally, malaria and human immunodeficiency virus (HIV) are both independently associated with a massive burden of disease and death. While their co-infection has been well studied for
Plasmodium falciparum
, scarce data exist regarding the association of
P. vivax
and HIV. In this cohort study, we assessed the effect of HIV on the risk of vivax malaria infection and recurrence during a 4-year follow-up period in an endemic area of the Brazilian Amazon. For the purpose of this study, we obtained clinical information from January 2012 to December 2016 from two databases. HIV screening data were acquired from the clinical information system at the tropical hospital
Fundação de Medicina Tropical Dr. Heitor Vieira Dourado
(FMT-HVD). The National Malaria Surveillance database (SIVEP malaria) was utilized to identify malaria infections during a 4-year follow-up period after diagnosis of HIV. Both datasets were combined via data linkage. Between 2012 and 2016, a total of 42,121 people were screened for HIV, with 1569 testing positive (3.7%). Out of all the patients diagnosed with HIV, 198 had at least one episode of
P. vivax
malaria in the follow-up. In the HIV-negative group, 711 participants had at least one
P. vivax
malaria episode. When comparing both groups, HIV patients had a 6.48 [(5.37–7.83);
P
 < 0.0001] (adjusted relative risk) greater chance of acquiring
P. vivax
malaria. Moreover, being of the male gender [ARR = 1.41 (1.17–1.71);
P
 < 0.0001], Amerindian ethnicity [ARR = 2.77 (1.46–5.28);
P
 < 0.0001], and a resident in a municipality of the Metropolitan region of Manaus [ARR = 1.48 (1.02–2.15);
P
 = 0.038] were independent risk factors associated with an increased risk of clinical malaria. Education ≥ 8 years [ARR = 0.41 (0.26–0.64);
P
 < 0.0001] and living in the urban area [ARR = 0.44 (0.24–0.80);
P
 = 0.007] were associated to a lower risk of
P. vivax
malaria. A total of 28 (14.1%) and 180 (25.3%) recurrences (at least a second clinical malaria episode) were reported in the HIV-positive and HIV-negative groups, respectively. After adjusting for sex and education, HIV-positive status was associated with a tendency towards protection from
P. vivax
malaria recurrences [ARR = 0.55 (0.27–1.10);
P
 = 0.090]. HIV status was not associated with hospitalizations due to
P. vivax
malaria. CD4 + counts and viral load were not associated with recurrences of
P. vivax
malaria. No significant differences were found in the distribution of parasitemia between HIV-negative and HIV-positive
P. vivax
malaria patients. Our results suggest that HIV-positive status is a risk factor for vivax malaria infection, which represents an additional challenge that should be addressed during elimination efforts.