title: Effects of HIV-1 serostatus, HIV-1 RNA concentration, and CD4 cell count on the incidence of malaria infection in a cohort of adults in rural Malawi.
abstract: BACKGROUND
  To assess the effects of human immunodeficiency virus (HIV) infection on susceptibility to malaria, we compared the incidence rates of malaria by HIV type 1 (HIV-1) serostatus, baseline blood HIV-1 RNA concentration, and baseline CD4 cell count, over the course of a malaria season.
  
  
  METHODS
  We followed a cohort of 349 adults in Malawi. For the 224 HIV-1-seropositive adults (64% of the cohort), we measured HIV-1 RNA concentration (n=187) and CD4 cell count (n=184) at baseline. Parasitemia was defined as presence of asexual parasites on a thick film of blood and was treated with sulfadoxine/pyrimethamine (SP), in accordance with national policy. Hazard ratios (HRs) of parasitemia were estimated using Cox regression. Demographics were adjusted for.
  
  
  RESULTS
  HIV-1 seropositivity was associated with parasitemia (adjusted HR, 1.8 [95% confidence interval {CI}, 1.2-2.7] for a first parasitemia episode; adjusted HR, 2.5 [95% CI, 1.5-4.2] for a second parasitemia episode [> 14 days after the first episode]; adjusted HR, 1.9 [95% CI, 1.4-2.6] for parasitemia overall). Treatment failure (parasitemia < or = 14 days after SP treatment) did not differ by HIV-1 serostatus (risk ratio, 1.3 [95% CI, 0.5-3.2]). HIV-1 RNA concentrations and CD4 cell counts were moderately but inconsistently associated with parasitemia. A high parasite density with fever was associated with HIV-1 seropositivity and low CD4 cell count.
  
  
  CONCLUSIONS
  HIV-infected adults in malaria-endemic areas are at increased risk for malaria. Where possible, additional malaria prevention efforts should be targeted at this population.
authors.affiliation: Department of Epidemiology, University of North Carolina at Chapel Hill, 27599, USA. piku@unc.edu
authors.forename: Padmaja
authors.initials: P
authors.lastname: Patnaik
authors.forename: Charles S
authors.initials: CS
authors.lastname: Jere
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.forename: Jack
authors.initials: J
authors.lastname: Wirima
authors.forename: Richard
authors.initials: R
authors.lastname: Pendame
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.forename: Terrie E
authors.initials: TE
authors.lastname: Taylor
authors.forename: Malcolm E
authors.initials: ME
authors.lastname: Molyneux
authors.forename: James G
authors.initials: JG
authors.lastname: Kublin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology* / Q000821:virology; D006679:HIV Seropositivity; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018512:Parasitemia; D010963:Plasmodium falciparum / Q000302:isolation & purification; D012367:RNA, Viral / Q000097:blood*; D012307:Risk Factors; D012424:Rural Population; D017211:Treatment Failure
chemical_list: D012367:RNA, Viral