Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa.
We assessed the impact of HIV-1 on malaria in the sub-Saharan African population. Relative risks for malaria in HIV-infected persons, derived from literature review, were applied to the HIV-infected population in each country, by age group, stratum of CD4 cell count, and urban versus rural residence. Distributions of CD4 counts among HIV-infected persons were modeled assuming a linear decline in CD4 after seroconversion. Averaged across 41 countries, the impact of HIV-1 was limited (although quantitatively uncertain) because of the different geographic distributions and contrasting age patterns of the 2 diseases. However, in Botswana, Zimbabwe, Swaziland, South Africa, and Namibia, the incidence of clinical malaria increased by < or =28% (95% confidence interval [CI] 14%-47%) and death increased by < or =114% (95% CI 37%-188%). These effects were due to high HIV-1 prevalence in rural areas and the locally unstable nature of malaria transmission that results in a high proportion of adult cases.
Korenromp
Eline L
EL
World Health Organization, Geneva, Switzerland. korenrompe@who.int
Williams
Brian G
BG
de Vlas
Sake J
SJ
Gouws
Eleanor
E
Gilks
Charles F
CF
Ghys
Peter D
PD
Nahlen
Bernard L
BL
D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D017677:Age Distribution; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000209:etiology / Q000401:mortality / Q000635:transmission; D015497:HIV-1; D006801:Humans; D015994:Incidence; D008288:Malaria / Q000209:etiology / Q000401:mortality / Q000635:transmission; D012423:Rural Health; D018571:Sentinel Surveillance; D014504:Urban Health