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HIV infection as a cofactor for severe falciparum malaria in adults living in a region of unstable malaria transmission in South Africa

Grimwade, Kate, French, Neil, Mbatha, D. D., Zungu, D. D., Dedicoat, Martin and Gilks, C.F. (2004) 'HIV infection as a cofactor for severe falciparum malaria in adults living in a region of unstable malaria transmission in South Africa'. AIDS, Vol 18, Issue 3, pp. 547-554.

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Abstract

Background: Malaria and HIV are two of the most important diseases facing Africa. It remains uncertain whether HIV-related immunosuppression adversely affects the clinical outcome of malaria.
Objective: To measure the association between HIV status and outcome from malarial infection in adults living in a region of unstable malaria transmission.
Design: Observational cohort study.
Setting: Four community clinics and the Government hospital in Hlabisa district, KwaZulu-Natal, South Africa; a region of high HIV prevalence.
Methods: Consecutive febrile adults were screened for malaria with a rapid antigen test. Those with malaria provided blood spots for HIV testing, a thick blood film for confirmation of malaria and clinical data. Outcome was established following management according to South African government guidelines.
Results: Malaria was microscopically confirmed in 613. HIV prevalence was 29.9% (180/613); 110 (18%) had severe/complicated malaria and 28 (4.6%) died. HIV-infected patients were more likely to vomit or be confused and were more likely to be admitted to hospital (P=0.05). In patients admitted to hospital, HIV infection was associated with severe/complicated malaria [adjusted odds ratio (OR) 2.3; 95% confidence interval (Cl), 1.4-3.9] and with death (OR 7.5; 95% Cl, 2.2-25.1). Acidosis and coma were also strong independent risk factors for death.
Conclusion: HIV infection had an unexpectedly large association with the outcome of falciparum malaria in a region of unstable transmission. Both diseases are widespread in Africa and these results add to the body of knowledge suggesting an interaction of significant public health importance between HIV and malaria in Africa. (C) 2004 Lippincott Williams Wilkins.

Item Type: Article
Additional Information: Article freely available online
Subjects: QX Parasitology > Protozoa > QX 135 Plasmodia
QZ Pathology > Manifestations of Disease > QZ 140 General manifestations of disease > QZ 150 Local reactions to injury and disease
WA Public Health > Preventive Medicine > WA 110 Prevention and control of communicable diseases. Transmission of infectious diseases
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications
WC Communicable Diseases > Tropical and Parasitic Diseases > WC 750 Malaria
Digital Object Identifer (DOI): https://doi.org/10.1097/01.aids.0000096909.73209.14
Depositing User: Sarah Lewis-Newton
Date Deposited: 08 May 2012 15:17
Last Modified: 21 Nov 2019 14:49
URI: https://archive.lstmed.ac.uk/id/eprint/2103

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