Abstract

Malaria and human immunodeficiency virus (HIV) infections are common, widespread and overlapping problems in the tropics. Despite this there has been minimal evidence to support an important interaction, other than during pregnancy in multigravid HIV-infected women. The lack of an interaction in other groups is surprising, and would be unexpected based on present knowledge of anti-malarial immunity. However, most of the reported studies have been cross-sectional and performed in selected groups, making their findings difficult to interpret. Two cohort studies in children were similarly inconclusive, although both hinted at a decreased ability to control parasitaemia with more advanced HIV-disease. Recent work from Entebbe carried out in a well-characterized cohort of HIV-infected adults revealed an increase in malarial fever with deteriorating immune status. Rates by CD4+ T-cell count groups >500, 200–499 and <200 cells/μL were 45, 73 and 115 cases per 1000 person-years respectively, P < 0·01 for trend. These findings support an important interaction between HIV and malaria. The public health consequences and the relevance of these findings outwith Entebbe are uncertain. The importance of understanding this interaction further must be a priority for sub-Saharan Africa: consequently further studies designed primarily to answer these questions will be necessary. Meanwhile, the optimism that the global malaria situation was largely unaffected by the HIV pandemic may need to be reconsidered.

References

Allen et al., 1991
Allen
S.
van de Perre
P.
Serufilira
A.
Lepage
P.
Carael
M.
DeClercq
A.
Tice
J.
Black
D.
Nsengumuremyi
F.
Ziegler
J.
Human immunodeficiency virus and malaria in a representative sample of childbearing women in Kigali, Rwanda
Journal of Infectious Diseases
 , 
1991
, vol. 
164
 (pg. 
67
-
71
)
Atzori et al., 1993
Atzori
C.
Bruno
A.
Chichino
G.
Cevini
C.
Bernuzzi
A.M.
Gatti
S.
Comolli
G.
Scaglia
M.
HIV-1 and parasitic infections in rural Tanzania
Annals of Tropical Medicine and Parasitology
 , 
1993
, vol. 
87
 (pg. 
585
-
593
)
Bloland et al., 1995
Bloland
P.B.
Wirima
J.J.
Steketee
R.W.
Chilima
B.
Hightower
A.
Breman
J.G.
Maternal HIV infection and infant mortality in Malawi: evidence for increased mortality due to placental malaria infection
AIDS
 , 
1995
, vol. 
9
 (pg. 
721
-
726
)
Chintu et al., 1995
Chintu
C.
Luo
C.
Bhat
G.
DuPont
H.L.
Mwansa-Salamu
P.
Kabika
M.
Zumla
A.
Impact of the human immunodeficiency virus type-1 on common pediatric illnesses in Zambia
Journal of Tropical Pediatrics
 , 
1995
, vol. 
41
 (pg. 
348
-
353
)
Colebunders et al., 1990
Colebunders
R.
Bahwe
Y.
Nekwei
W.
Ryder
R.
Perriens
J.
Nsimba
K.
Turner
A.
Francis
H.
Lebughe
I.
van der Stuyft
P.
Incidence of malaria and efficacy of oral quinine in patients recently infected with human immunodeficiency virus in Kinshasa, Zaire
Journal of Infection
 , 
1990
, vol. 
21
 (pg. 
167
-
173
)
Elliott et al., 1990
Elliott
A.M.
Luo
N.
Tembo
G.
Halwiindi
B.
Steenbergen
G.
Machiels
L.
Pobee
J.
Nunn
P.
Hayes
R.J.
McAdam
K.P.
Impact of HIV on tuberculosis in Zambia: a cross sectional study
British Medical Journal
 , 
1990
, vol. 
301
 (pg. 
412
-
415
)
French et al., 1998
French
N.
Gilks
C.F.
Mujugira
A.
Fasching
C.
O'Brien
J.
Janoff
E.N.
Pneumococcal vaccination in HIV-1-infected adults in Uganda: humoral response and two vaccine failures
AIDS
 , 
1998
, vol. 
12
 (pg. 
1683
-
1689
)
French et al., 2000
French
N.
Nakiyingi
J.
Carpenter
L.
Lugadda
E.
Watera
C.
Moore
M.
Moi
K.
Mulder
D.
Antvelink
D.
Janoff
E.
Whitworth
J.
Gilks
C.F.
A double-blind randomised and placebo controlled trial of 23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Ugandan adults
Lancet
 , 
2000
 
in press
Gilks et al., 1990
Gilks
C.F.
Brindle
R.J.
Otieno
L.S.
Simani
P.M.
Newnham
R.S.
Bhatt
S.M.
Lule
G.N.
Okelo
G.B.
Watkins
W.M.
Waiyaki
P.G.
Life-threatening bacteraemia in HIV-1 seropositive adults admitted to hospital in Nairobi, Kenya
Lancet
 , 
1990
, vol. 
336
 (pg. 
545
-
549
)
Gilks et al., 1992
Gilks
C.F.
Otieno
L.S.
Brindle
R.J.
Newnham
R.S.
Lule
G.N.
Were
J.B.O.
Simani
P.M.
Bhatt
S.M.
Okelo
G.B.
Waiyaki
P.G.
Warrell
D.A.
The presentation and outcome of HIV-related disease in Nairobi
Quarterly Journal of Medicine
 , 
1992
, vol. 
297
 (pg. 
25
-
32
)
Gilks et al., 1996
Gilks
C.F.
Ojoo
S.A.
Ojoo
J.C.
Brindle
R.J.
Paul
J.
Batchelor
B.I.
Kimari
J.N.
Newnham
R.
Bwayo
J.
Plummer
F.A.
Warrell
D.A.
Invasive pneumococcal disease in a cohort of predominantly HIV-1 infected female sex-workers in Nairobi, Kenya
Lancet
 , 
1996
, vol. 
347
 (pg. 
718
-
723
)
Greenberg et al., 1991
Greenberg
A.E.
Nsa
W.
Ryder
R.W.
Medi
M.
Nzeza
M.
Kitadi
N.
Baangi
M.
Malanda
N.
Davachi
F.
Hassig
S.E.
Plasmodium falciparum malaria and perinatally acquired human immunodeficiency virus type 1 infection in Kinshasa, Zaire. A prospective, longitudinal cohort study of 587 children
New England Journal of Medicine
 , 
1991
, vol. 
325
 (pg. 
105
-
109
)
Hoffman et al., 1999
Hoffman
I.F.
Jere
C.S.
Taylor
T.E.
Munthali
P.
Dyer
J.R.
Wirima
J.J.
Rogerson
S.J.
Kumwenda
N.
Eron
J.J.
Fiscus
S.A.
Chakraborty
H.
Taha
T.E.
Cohen
M.S.
Molyneux
M.E.
The effect of Plasmodium falciparum malaria on HIV-1 RNA blood plasma concentration
AIDS
 , 
1999
, vol. 
13
 (pg. 
487
-
494
)
Kalyesubula et al., 1997
Kalyesubula
I.
Musoke-Mudido
P.
Marum
L.
Bagenda
D.
Aceng
E.
Ndugwa
C.
Olness
K.
Effects of malaria infection in human immunodeficiency virus type 1-infected Ugandan children
Pediatric Infectious Diseases Journal
 , 
1997
, vol. 
16
 (pg. 
876
-
881
)
Müller and Moser, 1990
Müller
O.
Moser
R.
The clinical and parasitological presentation of Plasmodium falciparum malaria in Uganda is unaffected by HIV-1 infection
Transactions of the Royal Society of Tropical Medicine and Hygiene
 , 
1990
, vol. 
84
 (pg. 
336
-
338
)
Nguyen-Dinh et al., 1987
Nguyen-Dinh
P.
Greenberg
A.E.
Mann
J.M.
Kabote
N.
Francis
H.
Colebunders
R.L.
Huong
A.Y.
Quinn
T.C.
Davachi
F.
Lyamba
B.
Absence of association between Plasmodium falciparum malaria and human immunodeficiency virus infection in children in Kinshasa, Zaire
Bulletin of the World Health Organization
 , 
1987
, vol. 
65
 (pg. 
607
-
613
)
Serwadda et al., 1985
Serwadda
D.
Mugerwa
R.D.
Sewankambo
N.K.
Lwegaba
A.
Carswell
J.W.
Kirya
G.B.
Bayley
A.C.
Downing
R.G.
Tedder
R.S.
Clayden
S.A.
Slim disease: a new disease in Uganda and its association with HTLV-III infection
Lancet
 , 
1985
, vol. 
2
 (pg. 
849
-
852
)
Simooya et al., 1988
Simooya
O.
Mwendapole
R.
Siziya
S.
Fleming
A.
Relationship between falciparum malaria and HIV positivity in Ndola, Zambia
British Medical Journal
 , 
1988
, vol. 
297
 (pg. 
30
-
31
)
Steketee et al., 1996a
Steketee
R.W.
Wirima
J.J.
Bloland
P.B.
Chilima
B.
Mermin
J.H.
Chitsulo
L.
Breman
J.G.
Impairment of a pregnant woman's acquired ability to limit Plasmodium falciparum by infection with human immunodeficiency virus type-1
American Journal of Tropical Medicine and Hygiene
 , 
1996
, vol. 
55
 (pg. 
42
-
49
)
Steketee et al., 1996b
Steketee
R.W.
Wirima
J.J.
Slutsker
L.
Roberts
J.M.
Khoromana
C.O.
Heymann
D.L.
Breman
J.G.
Malaria parasite infection during pregnancy and at delivery in mother, placenta, and newborn: efficacy of chloroquine and mefloquine in rural Malawi
American Journal of Tropical Medicine and Hygiene
 , 
1996
, vol. 
55
 (pg. 
24
-
32
)
Steketee et al., 1998
Steketee
R.W.
Nahlen
B.D.
Ayisi
J.
Van Eijk
A.
Misore
A.
HIV and malaria overlap and do interact in sub-Saharan African pregnant women
Proceedings of the XIIth International Conference on AIDS abstract no. 13298
 , 
1998
pg. 
145
  
Geneva, 28 June–3 July 1998
Taha et al., 1994
Taha
T.E.T.
Canner
J.K.
Dallabetta
G.A.
Chiphangwi
J.D.
Liomba
G.
Wangel
A.M.
Saah
A.J.
Miotti
P.G.
Childhood malaria parasitaemia and human immunodeficiency virus infection in Malawi
Transactions of the Royal Society of Tropical Medicine and Hygiene
 , 
1994
, vol. 
88
 (pg. 
164
-
165
)
Verhoeff et al., 1999
Verhoeff
F.H.
Brabin
B.J.
Hart
C.A.
Chimsuku
L.
Kazembe
P.
Broadhead
R.L.
Increased prevalence of malaria in HIV-infected pregnant women and its implications for malaria control
Tropical Medicine and International Health
 , 
1999
, vol. 
4
 (pg. 
5
-
12
)

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