The authors declare that they have no competing interests.
AS and MS conceived of the study and participated in its design and coordination; AS drafted the manuscript. EAN, EACM, CdO and CM were responsible for data collection and participated to the study design. DM performed the statistical analysis. AA, DG, JF participated in the study coordination, interpretation of data and revised the paper critically. All authors read and approved the final manuscript.
Mozambique presents a very high prevalence of both malaria and HIV infection, but the impact of co-cancel infection on morbidity in this population has been rarely investigated. The aim of this study was to describe the prevalence and clinical characteristics of malaria in hospitalized adult HIV-positive patients, treated and untreated with combination anti-retroviral therapy (ART) and cotrimoxazole (CTX)-based chemoprophylaxis, compared to HIV negatives.
From November to December 2010, all adult patients consecutively admitted to the Department of Internal Medicine of Beira Central Hospital, Sofala Province, Mozambique, were submitted to HIV testing, malaria blood smear (MBS) and, in a subgroup of patients, also to the rapid malaria test (RDT). Socio-demographical and clinical data were collected for all patients. The association of both a positive MBS and/or RDT and diagnosis of clinical malaria with concomitant HIV infection (and use of CTX and/or ART) was assessed statistically. Frequency of symptoms and hematological alterations in HIV patients with clinical malaria compared to HIV negatives was also analysed. Sensitivity and specificity for RDT versus MBS were calculated for both HIV-positive and negative patients.
A total of 330 patients with available HIV test and MBS were included in the analysis, 220 of whom (66.7%) were HIV-positive. In 93 patients, malaria infection was documented by MBS and/or RDT. RDT sensitivity and specificity were 94% and 96%, respectively. According to laboratory results, the initial malaria suspicion was discarded in about 10% of cases, with no differences between HIV-positive and negative patients. A lower malaria risk was significantly associated with CTX prophylaxis (p=0.02), but not with ART based on non nucleoside reverse-transcriptase inhibitors (NNRTIs). Overall, severe malaria seemed to be more common in HIV-positive patients (61.7%) compared to HIV-negatives (47.2%), while a significantly lower haemoglobin level was observed in the group of HIV-positive patients (9.9±2.8mg/dl) compared to those HIV-negative (12.1±2.8mg/dl) (p=0.003).
Malaria infection was rare in HIV-positive individuals treated with CTX for opportunistic infections, while no independent anti-malarial effect for NNRTIs was noted. When HIV and malaria co-infection occurred, a high risk of complications, particularly anaemia, should be expected.
Centers for Disease Control and Prevention: Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents. mMWR. 2009, 58 (N RR4): 94-98.
Mermin J, Ekwaru JP, Liechty CA, Were W, Downing R, Ransom R, Weidle P, Lule J, Coutinho A, Solberg P: Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-treated bednets on the frequency of malaria in HIV-1-infected adults in Uganda: a prospective cohort study. Lancet. 2006, 367: 1256-61. 10.1016/S0140-6736(06)68541-3. CrossRefPubMed
Thera MA, Sehdev PS, Coulibaly D, Traore K, Garba MN, Cissoko Y, Kone A, Guindo A, Dicko A, Beavogui AH, Djimde AA, Lyke KE, Diallo DA, Doumbo OK, Plowe CV: Impact of trimethoprim-sulfamethoxazole prophylaxis on falciparum malaria infection and disease. J Infect Dis. 2005, 192: 823-29. CrossRef
HIV Epidemiological Surveillance Round, 2007.maputo: National Directorate of Medical Care, National STD/HIV/AIDS Control Program. 2008, Ministry of Health, Mozambique
UNAIDSCFS_AFRMOZ: EPIChart. 2011, last_access_11-20-2011_10.00.16_AM, http://aidsinfo.unaids.org
Worldmalaria Report. 2010, http://www.who.int/malaria/world_malaria_report_2010/worldmalariareport2010.pdf,
Gasasira AF, Kamya MR, Ochong EO, Vora N, Achan J, Charlebois E, Ruel T, Kateera F, Meya DN, Havlir D, Rosenthal PJ, Dorsey G: Effect of trimethoprim-sulphamethoxazole on the risk of malaria in HIV-infected Ugandan children living in an area of wide spread antifolate resistance. Malar J. 2010, 9: 177-10.1186/1475-2875-9-177. PubMedCentralCrossRefPubMed
Kapito-Tembo A, Meshnick SR, van Hensbroek MB, Phiri K, Fitzgerald M, Mwapasa V: Marked reduction in prevalence of malaria parasitemia and anemia in HIV-infected pregnant women taking cotrimoxazole with or without sulfadoxine-pyrimethamine intermittent preventive therapy during pregnancy in malawi. J Infect Dis. 2011, 203: 464-472. 10.1093/infdis/jiq072. PubMedCentralCrossRefPubMed
Walker AS, Forda D, Gilksb CF, Munderic P, Ssalid F, Reide A, Katabiraf E, Grosskurthc H, Mugyenyid P, Hakime J, Darbyshirea JH, Gibba DM, Babikera AG: Daily co-trimoxazole prophylaxis in severely immuno suppressed HIV-infected adults in Africa started on combination antiretroviral therapy: an observational analysis of the DART cohort. Lancet. 2010, 37: 1278-1286. CrossRef
Lek-Uthai U, Suwanarusk R, Ruengweerayut R, Skinner-Adams TS, Nosten F, Gardiner DL, Boonma P, Piera KA, Andrews KT, Machunter B, McARThy JS, Anstey NM, Price RN, Russell B: Stronger activity of human immuno deficiency virus type 1 protease inhibitors against clinical isolates of Plasmodium vivax than against those of P falciparum. Antimicrob Agents Chemother. 2008, 52: 2435-2441. 10.1128/AAC.00169-08. PubMedCentralCrossRefPubMed
Andrews KT, Fairlie DP, Madala PK, Ray J, Wyatt DM, Hilton PM, Melville LA, Beattie L, Gardiner DL, Reid RC, Stoermer MJ, Skinner-Adams T, Berry C, McArthy JS: Potencies of human immuno deficiency virus protease inhibitors in vitro against Plasmodium falciparum and in vivo against murinemalaria. Antimicrob Agents Chemother. 2006, 50: 639-648. 10.1128/AAC.50.2.639-648.2006. PubMedCentralCrossRefPubMed
Auld AF, Mbofana F, Shiraishi RW, Sanchez M, Alfredo C, Nelson LJ, Ellerbrock T: Four-year treatment outcomes of adult patients enrolled in mozambique’s rapidly expanding antiretroviral therapy program. PLoS ONE. 2011, 6: 18453-10.1371/journal.pone.0018453. CrossRef
AUmorris L, Distenfeld A, Amorosi E, Karpatkin S: Auto immune thrombocytopenic purpura in homosexual men. Ann Internmed. 1982, 96 (6 Pt 1): 714-
Berhane K, Karim R, Cohen M, Masri-Lavine L, Young M, Anastos K, Augenbraun M, Watts DH, Levine A: Impact of highly active antiretroviral therapy on anemia and relationship between anemia and survival in a large cohort of HIV-infected women. JAIDS. 2004, 37: 1245-1252. 10.1097/01.qai.0000134759.01684.27. PubMed
- Prevalence and clinical features of HIV and malaria co-infection in hospitalized adults in Beira, Mozambique
Edy A Nacarapa
Ézio A da Costa Massinga
Carlos de Oliveira
Josefo J Ferro
César A Macome
- BioMed Central
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