Increased severe anemia in HIV-1-exposed and HIV-1-positive infants and children during acute malaria.
OBJECTIVE
Since the primary hematological complication in both pediatric HIV-1 and malaria is anemia, co-infection with these pathogens may promote life-threatening severe malarial anemia (SMA). The primary objective of the study was to determine if HIV-1 exposure [HIV-1(exp)] and/or HIV-1 infection [HIV-1(+)] increased the prevalence of SMA in children with acute malaria.


METHODS
The effect of HIV-1 exposure and HIV-1 infection on the prevalence of SMA (hemoglobin < 6.0 g/dl), parasitemia (parasites/microl), and high-density parasitemia (HDP, >or= 10 000 parasites/mul) was investigated in children <or= 2 years of age presenting at hospital with acute Plasmodium falciparum malaria in a rural holoendemic malaria transmission area of western Kenya.


METHODS
Upon enrollment, a complete hematological and clinical evaluation was performed on all children. Malaria parasitemia was determined and children with acute P. falciparum malaria were evaluated for HIV-1 exposure and infection by two rapid serological antibody tests and HIV-1 DNA PCR, respectively.


RESULTS
Relative to HIV-1(-) group (n = 194), the HIV-1(exp) (n = 100) and HIV-1(+) (n = 23) groups had lower hemoglobin concentrations (P < 0.001 and P < 0.001, respectively), while parasitemia and HDP were equivalent between the three groups. Multivariate analyses demonstrated that the risk of SMA was elevated in HIV-1(exp) children (odds ratio, 2.17; 95% confidence interval, 1.25-3.78; P < 0.01) and HIV-1(+) children (odds ratio, 8.71; 95% confidence interval, 3.37-22.51; P < 0.0001). The multivariate model further revealed that HIV-1 exposure or infection were not significantly associated with HDP.


CONCLUSIONS
Results presented here demonstrate that both HIV-1 exposure and HIV-1 infection are associated with increased prevalence of SMA during acute P. falciparum infection, independent of parasite density.
Otieno
Richard O
RO
Department of Zoology, Maseno University, Kisumu, Kenya.
Ouma
Collins
C
Ong'echa
John M
JM
Keller
Christopher C
CC
Were
Tom
T
Waindi
Eliud N
EN
Michaels
Marian G
MG
Day
Richard D
RD
Vulule
John M
JM
Perkins
Douglas J
DJ
D000208:Acute Disease; D000740:Anemia / Q000097:blood / Q000469:parasitology* / Q000821:virology*; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1 / Q000302:isolation & purification*; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007630:Kenya; D016778:Malaria, Falciparum / Q000150:complications*; D008297:Male; D018512:Parasitemia / Q000150:complications; D012423:Rural Health / Q000706:statistics & numerical data
D006454:Hemoglobins