The effect of HIV on morbidity and mortality in children with severe malarial anaemia.
BACKGROUND
Malaria and HIV are common causes of mortality in sub-Saharan Africa. The effect of HIV infection on morbidity and mortality in children with severe malarial anaemia was assessed.


METHODS
Children <5 years old were followed as part of a prospective cohort study to assess the transfusion-associated transmission of blood-borne pathogens at Mulago Hospital, Kampala, Uganda. All children were hospitalized with a diagnosis of severe malarial anaemia requiring blood transfusion. Survival to different time points post-transfusion was compared between HIV-infected and uninfected children. Generalized estimating equations were used to analyse repeated measurement outcomes of morbidity, adjusting for confounders.


RESULTS
Of 847 children, 78 (9.2%) were HIV-infected. Median follow-up time was 162 days (inter-quartile range: 111, 169). HIV-infected children were more likely to die within 7 days (Hazard ratio [HR] = 2.86, 95% Confidence interval [CI] 1.30-6.29, P = 0.009) and within 28 days (HR = 3.70, 95% CI 1.91-7.17, P < 0.001) of an episode of severe malarial anaemia, and were more likely to die in the 6 months post-transfusion (HR = 5.70, 95% CI 3.54-9.16, P < 0.001) compared to HIV-uninfected children. HIV-infected children had more frequent re-admissions due to malaria within 28 days (Incidence rate ratio (IRR) = 3.74, 95% CI 1.41-9.90, P = 0.008) and within 6 months (IRR = 2.66, 95% CI 1.17 - 6.07, P = 0.02) post-transfusion than HIV-uninfected children.


CONCLUSIONS
HIV-infected children with severe malarial anaemia suffered higher all-cause mortality and malaria-related mortality than HIV-uninfected children. Children with HIV and malaria should receive aggressive treatment and further evaluation of their HIV disease, particularly with regard to cotrimoxazole prophylaxis and antiretroviral therapy.
Malamba
Samuel
S
CDC-Uganda, Global AIDS Program, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA. zcq2@UG.CDC.GOV
Hladik
Wolfgang
W
Reingold
Arthur
A
Banage
Flora
F
McFarland
Willi
W
Rutherford
George
G
Mimbe
Derrick
D
Nzaro
Esau
E
Downing
Robert
R
Mermin
Jonathan
J
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000401:mortality*; D000740:Anemia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000469:parasitology; D017848:Blood-Borne Pathogens; D002675:Child, Preschool; D015331:Cohort Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007223:Infant; D008288:Malaria / Q000150:complications* / Q000453:epidemiology; D009017:Morbidity; D011446:Prospective Studies; D065227:Transfusion Reaction