Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi: a prospective cohort study.
BACKGROUND
Raised HIV viral load in blood has been associated with accelerated disease progression and increased transmission of infection. To assess the effect of Plasmodium falciparum malaria on concentrations of HIV in blood, we did a prospective cohort study in Malawi.


METHODS
We recruited 367 HIV-1-infected adults. Among 334 people aparasitaemic at baseline, 148 had at least one malaria episode during follow-up and received antimalarial treatment. Of these, 77 had HIV-1-RNA measurements at baseline, during malaria, and post-malaria. We used linear regression with generalised estimating equations to assess effect of four definitions of malaria (any parasitaemia, parasite density > or =2000/microL, febrile parasitaemia, and febrile parasitaemia with parasite density > or =2000/microl) on changes in log HIV-1 RNA, overall and by baseline CD4 count.


RESULTS
With malaria defined as any parasitaemia, HIV-1-RNA concentration almost doubled between baseline (median 96215 copies per mL) and malaria (168901 copies per mL), a 0.25 (95% CI 0.11-0.39) log increase in mean RNA concentration. HIV-1-RNA concentration fell to median 82058 copies per mL by about 8-9 weeks post-malaria. Increases in HIV-1-RNA were greatest for people with fever, parasite density 2000/microL or greater, and CD4 count more than 300 cells per muL, in whom concentrations rose from median 38483 copies per mL at baseline to 196098 copies per mL during malaria, a mean log increase of 0.82 (95% CI 0.55-1.10, p<0.0001), and fell to median 75331 copies per mL post-malaria. People who remained aparasitaemic showed no changes in HIV-1-RNA concentration.


CONCLUSIONS
HIV-infected individuals with malaria have a significantly increased viral load, which might enhance HIV transmission and accelerate disease progression.
Kublin
James G
JG
Department of Community Health, University of Malawi College of Medicine, Blantyre, Malawi. jkublin@fhcrc.com
Patnaik
Padmaja
P
Jere
Charles S
CS
Miller
William C
WC
Hoffman
Irving F
IF
Chimbiya
Nelson
N
Pendame
Richard
R
Taylor
Terrie E
TE
Molyneux
Malcolm E
ME
D000293:Adolescent; D000328:Adult; D000368:Aged; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications / Q000469:parasitology / Q000821:virology*; D008295:Malawi; D008297:Male; D008875:Middle Aged; D018512:Parasitemia; D012367:RNA, Viral / Q000097:blood*; D019562:Viral Load
D012367:RNA, Viral