Afr Health Sci. 2013 Jun;13(2):295-300.

Malaria and HIV co-infection and their effect on haemoglobin levels from three health-care institutions in Lagos, southwest Nigeria.

Sanyaolu AO, Fagbenro-Beyioku AF, Oyibo WA, Badaru OS, Onyeabor OS, Nnaemeka CI.

Department of Medical Microbiology and Parasitology, College of Medicine of the University of Lagos, Idi-araba, PMB 12003 Lagos, Nigeria ; Central Public Health Laboratory of the Federal Ministry of Health, Yaba, Lagos, Nigeria ; Department of Medical Microbioloy and Immunology, St. James School of Medicine, Albert Lake Dr. The Quarter, P. O. Box 318, The Valley, Anguilla, BWI.

 

Background

Malaria remains one of the leading causes of morbidity and mortality globally and nearly half of the global populations are at risk of malaria infection. Malaria and human immunodeficiency virus (HIV) infection accounted for over 3 million deaths in 2007 and millions more are adversely affected each year (1). The prevalence of malaria and HIV infection overlaps in most endemic regions and co-infection of these infections have important public health implications. While early population-based studies reported no association between malaria and HIV co-infection, recent study indicated malaria as a risk factor of concurrent HIV infection at the population level (2, 3).

Malaria is believed to increase HIV replication in vitro and in vivo. In addition, evidence shows that malaria co-infection with HIV triggers malaria disease progression, increases the risk of severe malaria in adults, increases risk of congenital infection and this dual infection fuels the spread of both diseases especially in sub-Saharan Africa. This compelling evidence has called for integrated health sciences for early, effective and preventive treatment of both infections. In pregnant women, HIV infection increases the risk of high-density Plasmodium falciparum infection, higher risk of maternal anemia and low birth weight. HIV and malaria each interact with the host’s immune system, and this interaction often results in a complex activation of immune cells which cause dysfunctional levels of cytokine and antibody productions. In addition, CD4+ T cells have a major role in the development and maintenance of antimalarial immunity, but HIV infections meddle with this immunity (4, 5, 6).

Objective

This study examined the prevalence of malaria and HIV co-infection as well as anemia among selected patients from three health-care institutions in Lagos.

Findings

Among the 1080 selected patients, 293 (27.1%) were infected with malaria parasites and 31 (2.9%) with malaria/HIV co-infection. The patients consisted of 570 (52.8%) males and 510 (47.2%) females. P. falciparum and P. malariae were the only two types of malaria parasite species found in the blood smear of the sampled patients. Infection with P. falciparum 24.8% (268/1080) recorded the highest prevalence among the patients when compared with P. malariae 0.6% (7/1080) and 1.7% (18/1080) had mixed infection with both parasites. There were no significant differences between the prevalence of P. falciparum malaria in HIV sero-positive and seronegative patients. However, the prevalence of P. malariae was statistically significantly higher in HIV sero-positive patients though the sample size was small. In addition, mixed malaria infection was also statistically significantly higher among HIV seropositive patients when compared with HIV seronegative patients (6.2% versus 1.4%). The total number of malaria infected patients was significantly higher in HIV sero-positive patients (47.7%) than the HIV sero-negative patients (25.8%).

Among the respondents, analysis from the questionnaire showed that there were no major differences in the prevalence of parasitaemia with patients who reportedly used anti-malarial drugs two weeks prior to the study irrespective of their HIV status. In total, 4.2% (45/1080) of the recruited patients reportedly used anti-malarial treatment prior to the study and still had parasitaemia. Out of which 40% (18/45) were HIV sero-positive and 60% (27/ 45) HIV sero-negative patients. Although there were no statistical significance with the categories of parasite density in relation to the patients’ HIV status, the median parasite density in HIV sero-negative patients was higher than that of the HIV sero-positive patients. Analysis from the questionnaire also indicated that there were no statistically significant differences in the frequency of malaria attack between the HIV sero-positive and HIV sero-negative patients while it tended to be higher among HIV sero-positives. Since anaemia is the most frequent haematological consequence of malaria and HIV infection, their association was explored. No selected patient had severe malaria anaemia during the study. Taken together, only 3.4% (37/1080) of the recruited patients had anaemia at the time of the study. However, patients with malaria and HIV co-infection had higher odds of anaemia than patients with malaria alone in multivariable logistic regression analysis (11.1% versus 25.8%), adjusted OR 2.4 (95% CI, 1.3 to 2.7, P = 0.014).

Conclusion

Study data indicated a higher prevalence of malaria in HIV infected patients and also revealed that patients with malaria and HIV co-infection were more likely to have anaemia than patients with only malaria infection.

PMID: 24235927

 

References

  1. WHO. World Malaria Report 2008. WHO Press, Geneva, Switzerland. 2008.
  2. Nguyen-Dinh P, Greenberg AE, Mann JM, Kabote N, Francis H, Colebunders RL, Huong AY, Quinn TC, Davachi F, Lyamba B, et al. Absence of association between Plasmodium falciparum malaria and human immunodeficiency virus infection in children in Kinshasa, Zaire. Bulletin of the World Health Organization 1987; 65:607-13.
  3. Cuadros DF, Branscum AJ, Crowley PH. HIV malaria co-infection: effects of malaria on the prevalence of HIV in East sub-Saharan Africa. International Journal of Epidemiology 2011; 40:931-9.
  4. Perrault SD, Hajek J, Zhong K, Owino SO, Sichangi M, Smith G, Shi YP, Moore JM, Kain KC. Human immunodeficiency virus coinfection increases placental parasite density and transplacental malaria transmission in Western Kenya. The American Journal of Tropical Medicine and Hygiene 2009; 80:119-25.
  5. Van geertruyden JP, D’Alessandro U. Malaria and HIV: a silent alliance. Trends in Parasitology 2007; 23:465-7.
  6. Van Geertruyden, J. P. “Interactions between malaria and human immunodeficiency virus anno 2014.” Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases 20.4 (2014): 278.

 

Contact:

Dr. Adekunle O. Sanyaolu

Department of Medical Microbiology and Immunology,

St. James School of Medicine, Albert Lake Dr.

The Quarter, P. O. Box 318; The Valley,

Anguilla, BWI

Email: sanyakunle@hotmail.com

 

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