Hematological predictors of increased severe anemia in Kenyan children coinfected with Plasmodium falciparum and HIV‐1

Abstract

Malaria and HIV‐1 are coendemic in many developing countries, with anemia being the most common pediatric hematological manifestation of each disease. Anemia is also one of the primary causes of mortality in children monoinfected with either malaria or HIV‐1. Although our previous results showed HIV‐1(+) children with acute Plasmodium falciparum malaria [Pf(+)] have more profound anemia, potential causes of severe anemia in coinfected children remain unknown. As such, children with P. falciparum malaria (aged 3–36 months, n = 542) from a holoendemic malaria transmission area of western Kenya were stratified into three groups: HIV‐1 negative [HIV‐1(−)/Pf(+)]; HIV‐1 exposed [HIV‐1(exp)/Pf(+)]; and HIV‐1 infected [HIV‐1(+)/Pf(+)]. Comprehensive clinical, parasitological, and hematological measures were determined upon enrollment. Univariate, correlational, and hierarchical regression analyses were used to determine differences among the groups and to define predictors of worsening anemia. HIV‐1(+)/Pf(+) children had significantly more malarial pigment‐containing neutrophils (PCN), monocytosis, increased severe anemia (Hb < 6.0 g/dL), and nearly 10‐fold greater mortality within 3 months of enrollment. Common causes of anemia in malaria‐infected children, such as increased parasitemia or reduced erythropoiesis, did not account for worsening anemia in the HIV‐1(+)/Pf(+) group nor did carriage of sickle cell trait or G6PD deficiency. Hierarchical multiple regression analysis revealed that more profound anemia was associated with elevated PCM, younger age, and increasing HIV‐1 status ([HIV‐1(−) → HIV‐1(exp) → HIV‐1(+)]. Thus, malaria/HIV‐1 coinfection is characterized by more profound anemia and increased mortality, with acquisition of monocytic pigment having the most detrimental impact on Hb levels. Am. J. Hematol., 2010. © 2010 Wiley‐Liss, Inc.

Enhanced T cell activation in Plasmodium falciparum malaria-infected human immunodeficiency virus-1 patients from Mozambique

“…In addition, the Hg concentration and PD are not correlated in the Pf/HIV co-infected patients or the malaria only patients. These results are consistent with other studies of malaria transmission in sub-Saharan Africa areas, such as Cameroon (Nkuo Akenji et al 2002) and Kenya (Davenport et al 2010). However, conflicting results regarding anaemia have also been observed in Kenya (Mc Elroy et al 2000) and Tanzania (Ekval et al 2001).…”

“…Most of the available data regarding malaria-associated HIV-AIDS is related to the consequences of HIV infection on the degree of anaemia, Plasmodium PD and CD4 + T lymphocyte counts in Pf malaria patients, particularly in sub-Saharan Africa countries (Whitworth et al 2000, Cohen et al 2005, Mouala et al 2009, Davenport et al 2010. However, the impact of both infections on the state of immune cellular activation is largely unknown.…”

“…107(8): 985-992, December 2012 As leading causes of morbidity and mortality, malaria and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) are two of the most important diseases in Africa (Idemyor et al 2007). Plasmodium falciparum-associated HIV-1 (Pf/HIV) infection has been described in many sub-Saharan Africa countries and data from these countries account for most of the available clinical data regarding this co-infection (Chalwe et al 2009, Davenport et al 2010, Kiyingi et al 2010, Mills et al 2010, Serna-Bolea et al 2010, Naniche et al 2011. A relevant issue in malaria-endemic regions is the identification of HIV/AIDS patients among suspected cases of acute malaria (Mills et al 2010, Serna-Bolea et al 2010.…”

“…Patients with low CD4 + T cell counts of less than 350 cells/mm 3 are more likely to exhibit complications arising malaria (Cohen et al 2005, Mouala et al 2009). Moreover, HIV-1 infection is associated with an increased prevalence of anaemia in Pf malaria (Otieno et al 2006, Davenport et al 2010. Malaria can also affect HIV-1 infection.…”

All that glitters is gold?

“…There is urgent need for quick, reliable, and low-cost assays that would improve assessment and prediction of disease severity and mortality. Two studies in this issue of the American Journal of Hematology [7,8] take a cautious step forward in this direction.…”