Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

BACKGROUND: An association between HIV-1 and malaria is expected in theory, but has not been convincingly shown in practice. We studied the effects of HIV-1 infection and advancing immunosuppression on falciparum parasitaemia and clinical malaria. METHODS: HIV-1-positive and HIV-1-negative adults selected from a population-based cohort in rural Uganda were invited to attend a clinic every 3 months (routine visits) and whenever they were sick (interim visits). At each visit, information was collected on recent fever, body temperature, and malaria parasites. Participants were assigned a clinical stage at each routine visit and had regular CD4-cell measurements. FINDINGS: 484 participants made 7220 routine clinic visits between 1990 and 1998. Parasitaemia was more common at visits by HIV-1-positive individuals (328 of 2788 [11.8%] vs 231 of 3688 [6.3%], p<0.0001). At HIV-1-positive visits, lower CD4-cell counts were associated with higher parasite densities, compared with HIV-1-negative visits (p=0.0076). Clinical malaria was significantly more common at HIV-1-positive visits (55 of 2788 [2.0%] vs 26 of 3688 [0.7%], p=0.0003) and the odds of having clinical malaria increased with falling CD4-cell count (p=0.0002) and advancing clinical stage (p=0.0024). Participants made 3377 interim visits. The risk of clinical malaria was significantly higher at visits by HIV-1-positive individuals than HIV-1-negative individuals (4.0% vs 1.9%, p=0.009). The risk of clinical malaria tended to increase with falling CD4-cell counts (p=0.052). INTERPRETATION: HIV-1 infection is associated with an increased frequency of clinical malaria and parasitaemia. This association tends to become more pronounced with advancing immunosuppression, and could have important public-health implications for sub-Saharan Africa.

Original publication

DOI

10.1016/S0140-6736(00)02727-6

Type

Journal article

Journal

Lancet

Publication Date

23/09/2000

Volume

356

Pages

1051 - 1056

Keywords

Africa, Africa South Of The Sahara, Biology, Demographic Factors, Developing Countries, Diseases, Eastern Africa, English Speaking Africa, Hiv Infections, Immunity, Immunological Effects, Malaria, Parasitic Diseases, Physiology, Population, Population Characteristics, Research Report, Rural Population, Uganda, Viral Diseases, Adolescent, Adult, Aged, Aged, 80 and over, CD4 Lymphocyte Count, Child, Cohort Studies, Female, Fever, HIV Infections, HIV Seronegativity, HIV Seropositivity, HIV-1, Humans, Immunosuppression, Malaria, Falciparum, Male, Middle Aged, Office Visits, Pregnancy, Rural Population, Severity of Illness Index, Uganda