Should We Care About Plasmodium Vivax and HIV Coinfection? A Systematic Review and a Cases Series From the Brazilian Amazon

Abstract

Background. Malaria and HIV are two important public health issues. However, data on HIV-Plasmodium vivax co-infection (HIV/PvCo) is scarce, with most of the available data related to P. falciparum in the African region. It is unclear whether HIV can change the clinical course of Plasmodium vivax (Pv) malaria, and thereby increase the risk of complications. In this study, a systematic review of the HIV/PvCo is presented, including new cases from the Brazilian Amazon. Methods. Medical records from a tertiary care center in the Western Brazilian Amazon (2009 to 2018) were reviewed to identify HIV/PvCo hospitalized patients. Demographic, clinical and laboratory characteristics, and outcomes are reported. We also performed a systematic review of published studies on HIV/PvCo. Metadata, number of HIV/PvCo cases, demographic, clinical, and outcome data were extracted if available. Results. A total of 1048 vivax malaria patients were hospitalized in the 10-year period; 21 (2.0%) were HIV/PvCo cases, of which nine (42.9%) had AIDS-defining illnesses. For eleven (52.4%) patients, this was their first malaria infection. Seven (33.3%) patients were unaware of their HIV status and were diagnosed at hospitalization. Severe malaria criteria were found in 5 (23.8%) patients. One patient died. The systematic review provided 17 articles (12 cross-sectional or longitudinal studies and 5 case report studies). A higher prevalence of studies involved cases in African and Asian countries (35.3% and 29.4%, respectively), and the prevalence of reported co-infections ranged from 0.1 to 60%. Cases of severe malaria-HIV coinfection were not reported. Conclusion. Reports of HIV/PvCo are scarce in the literature, with only a few studies describing clinical and laboratory outcomes. Systematic screening for both co-infections are not performed, and therefore, a realistic prevalence of HIV/PvCo is absent. This study showed a low prevalence of HIV/PvCo, despite local malaria and HIV high prevalence. Even though relatively small, this is the largest case series to describe HIV/PvCo.