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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Increased prevalence of severe malaria in HIV-infected adults in South Africa
Clinical Infectious Diseases, Volume 41, No. 11, Year 2005
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Description
Background. Conflicting reports exist regarding the impact of human immunodeficiency virus (HIV) infection on the risk of severe malaria. We aimed to assess the effect of HIV infection status, advancing immunosuppression, and antimalarial immunity on the severity of malaria. Methods. A prospective cohort study was conducted. Consecutive hospitalized adult patients with falciparum malaria were tested for HIV antibodies and to determine CD4+ T cell count. Immunity to malaria was assessed by obtaining a history of childhood residence in an area where malaria is endemic. Patients were assessed for features of severe malaria. Results. Three hundred thirty-six patients were enrolled in the study, of whom 32 (10%) had severe malaria. The prevalence of HIV infection was 33%, and 111 patients (33%) were nonimmune to malaria. HIV-infected patients complained more frequently about respiratory and abdominal symptoms and less frequently about rigors and headache. Risk factors for severe malaria determined by multivariate analysis included being nonimmune to malaria, having a positive HIV serostatus, having an elevated parasite count, and having an increased white blood cell count. Risk of severe malaria was increased in HIV-infected patients with a CD4+ T cell count of <200 × 106 cells/L (P ≤ .001). Nonimmune HIV-infected patients were significantly more likely to have severe malaria (13 [36%] of 36 patients) than were nonimmune non-HIV-infected patients (9 [12%] of 75 patients; odds ratio, 4.15 [95% confidence interval, 1.57-10.97]; P = .003). HIV serostatus did not affect risk of severe malaria in the group from an area with endemicity (5 [7%] of 74 HIV-infected patients had severe malaria, and 5 [3%] of 151 non-HIV-infected patients had malaria; P = .248). Conclusions. HIV-infected nonimmune adults are at increased risk of severe malaria. This risk is associated with a low CD4+ T cell count. This interaction is of great public health importance. © 2005 by the Infectious Diseases Society of America. All rights reserved.
Authors & Co-Authors
Cohen, Cheryl D.
South Africa, Johannesburg
National Health Laboratory Service
Karstaedt, Alan S.
South Africa, Johannesburg
University of the Witwatersrand
Frean, John Andrew
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Johannesburg
National Institute for Communicable Diseases
Thomas, Juno
South Africa, Johannesburg
National Health Laboratory Service
Govender, Melesh
South Africa, Johannesburg
National Health Laboratory Service
Prentice, Elizabeth
South Africa, Johannesburg
National Health Laboratory Service
Davidsson, L. A.
South Africa, Johannesburg
National Health Laboratory Service
South Africa, Johannesburg
National Institute for Communicable Diseases
Galpin, Jacqueline Suzanne
South Africa, Johannesburg
University of the Witwatersrand
Crewe-Brown, Heather H.
South Africa, Johannesburg
National Health Laboratory Service
Statistics
Citations: 185
Authors: 9
Affiliations: 3
Identifiers
Doi:
10.1086/498023
ISSN:
10584838
Research Areas
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Approach
Quantitative
Study Locations
South Africa