Human immunodeficiency virus type 1 infection in patients with severe falciparum malaria in urban India.
BACKGROUND
CD4+ T cells restrict parasitaemia during the first attack of falciparum malaria; humoral immunity, develops weeks later and protects against reinfection. HIV infection may affect severity of falciparum malaria and development of protective immunity.


OBJECTIVE
To study the prevalence of HIV infection in Indian patients with severe falciparum malaria and its effect on severity of illness and recurrences of and mortality related to malarial infection.


METHODS
Consecutive patients with severe falciparum malaria and voluntary blood donors.


METHODS
Prospective cohort study in a university hospital in Mumbai.


RESULTS
Five (11.6%) of 43 patients and 521 (1.8%) of 28749 blood donors had HIV infection (OR 7.1, 95% CI = 2.8 to 18.2, p=0.001). Clinical features, APACHE II score, number of organs affected, parasite index and mortality in patients with and without HIV infection were comparable. CD4+ counts were < 500 cells/ microl in 2 patients and normal in 3. Opportunistic infections including pulmonary tuberculosis in one patient (CD4+ counts > 500 cells/ microl), and oral candidiasis in two (CD4+ counts 275 and 250 cells/ microl) were noted. One patient developed fatal Pneumocystis carinii pneumonia two weeks after recovering from malaria. P. falciparum infection recurred in 2 of the 4 HIV infected survivors and in none of 31 survivors without HIV infection (RR 38.8, 95% CI 2.2 to 671, p=0.01).


CONCLUSIONS
HIV infection is associated with increased risk of severe malaria even with normal CD4+ counts; severity of disease and mortality are not increased. However, prior HIV infection impairs protective immune response to Plasmodium falciparum in residents of hypoendemic areas.
Khasnis
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AA
Department of Medicine, K. E. M. Hospital, Parel, Mumbai - 400012, India. karnad@vsnl.net
Karnad
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DR
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D007194:India / Q000453:epidemiology; D016778:Malaria, Falciparum / Q000453:epidemiology* / Q000209:etiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D015996:Survival Rate; D014505:Urban Population / Q000706:statistics & numerical data*