title: HIV-1 immune suppression and antimalarial treatment outcome in Zambian adults with uncomplicated malaria.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-1 infected adults with low CD4 cell count have a higher risk of malaria infection and clinical malaria. We assessed the influence that HIV-1 immune suppression has on the efficacy of antimalarial treatment in adults with uncomplicated malaria.
  
  
  METHODS
  This clinical trial included 971 Zambian adults with uncomplicated malaria. Patients were tested for HIV-1, and, if positive, a CD4 cell count was assessed. The primary outcome was recurrent parasitemia corrected by molecular genotyping within 45 days after treatment.
  
  
  RESULTS
  HIV-1 infection was detected in 33% (320/971) of adult patients with malaria. Treatment failure was not associated with HIV-1 infection (relative risk [RR], 1.12 [95% confidence interval {CI}, 0.82-1.53]; P=.45). HIV-1-infected patients with a CD4 cell count <300 cells/microL had an increased risk of recurrent parasitemia, compared with those with a CD4 cell count >or=300 cells/microL (RR, 2.24 [95% CI, 1.20-4.14]; P=.01). After genotyping, the risk of recrudescence was higher in HIV-1-infected patients with a CD4 cell count <300 cells/microL than in the other patients with malaria (RR, 1.67 [95% CI, 1.13-2.47]; P=.02).
  
  
  CONCLUSIONS
  HIV-1-infected patients with malaria with a CD4 cell count <300 cells/microL have a higher risk of experiencing a recrudescent infection, compared with those with a CD4 cell count >or=300 cells/microL or without HIV-1 infection. Trial registered at http://www.clinicaltrials.gov/; reference number NCT00304980.
authors.affiliation: Department of Parasitology, Unit of Epidemiology, Institute of Tropical Medicine, Nationalestraat 155 B2000 Antwerp, Belgium. jpvangeertruyden@itg.be
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Van Geertruyden
authors.forename: Modest
authors.initials: M
authors.lastname: Mulenga
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mwananyanda
authors.forename: Victor
authors.initials: V
authors.lastname: Chalwe
authors.forename: Filip
authors.initials: F
authors.lastname: Moerman
authors.forename: Roma
authors.initials: R
authors.lastname: Chilengi
authors.forename: Webster
authors.initials: W
authors.lastname: Kasongo
authors.forename: Chantal
authors.initials: C
authors.lastname: Van Overmeir
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dujardin
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Luc
authors.initials: L
authors.lastname: Kestens
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D000077549:Artemether; D037621:Artemisinins / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D004338:Drug Combinations; D004983:Ethanolamines / Q000627:therapeutic use; D005260:Female; D005449:Fluorenes / Q000627:therapeutic use; D015658:HIV Infections / Q000276:immunology* / Q000503:physiopathology / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D007165:Immunosuppression Therapy; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D011739:Pyrimethamine / Q000627:therapeutic use; D013413:Sulfadoxine / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome; D015024:Zambia
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D000077549:Artemether; D000078102:Lumefantrine; D011739:Pyrimethamine