The interaction between HIV and malaria in Africa

Abstract

HIV and malaria kill millions of people every year. They share a common geographic distribution, and both cause far more disease and death in sub-Saharan Africa than they do in the rest of the world. Many epidemiologic studies have suggested that HIV and malaria coexist independently, but some recent reports describe synergistic interactions between them. People living with HIV infection who do not have pre-existing immunity to malaria experience a marked increase in malaria severity. But for those who have acquired immunity through natural exposure to malaria, HIV-related immunosuppression is associated with only a modest increase in clinical malaria, which may be explained in part by more frequent nonmalaria febrile episodes. The effect of malaria infection on HIV disease progression due to increased viral replication may be important but has not yet been fully explored.

Interaction of malaria and HIV in Africa

“…3 Malaria is more common and severe in adults with HIV, pregnant women, and children. 4 HIV viral load is greater in women with placental malaria, and infants born to women with both HIV and placental malaria are of greater risk of premature delivery, low birth weight, or death compared with infants born to women with HIV infection alone. Malaria causes increased HIV viral load in blood and breast milk and reduced CD4 cell count.…”

Coinfection with HIV and Tropical Infectious Diseases. I. Protozoal Pathogens

“…Although initial reports did not demonstrate interactions, complex bidirectional interactions between infection with P. falciparum and HIV have since been found [5,6]. Part of the complexity relates to the epidemiology and immunobiology of malaria itself.…”

“…In regions with unstable or low transmission, the burden falls more equally on adults and children, and the relationship between parasitemia and disease is more direct [7]. Not unexpectedly, the interplay between HIV infection and malaria varies according to the dynamics of malaria transmission [5].…”

“…HIV infection is presumably also a risk factor for severe malaria in young children in regions of heavy transmission, but firm data are lacking [5]. In contrast, HIV infection appears to only modestly increase the risk of parasitemia and clinical malaria in semi-immune adults in regions of holoendemicity.…”

Clinical management of HIV infection in children

“…BCG, however, is usually given at or around birth prior to the determination of infection status, the benefits for the child of unknown HIV status are currently felt to outweigh the risks and routine BCG should usually continue to be given. Malaria is common in areas with high rates of HIV infection, and increasingly interactions between HIV and malaria are being recognized [71,72]. A recent review by Slutsker [73] emphasizes the importance of preventive measures including routine provision of co-trimoxazole and the use of insecticide bed nets for HIV-infected adults and children with malaria.…”