title: The effect of HIV on morbidity and mortality in children with severe malarial anaemia.
abstract: 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.
authors.affiliation: 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
authors.forename: Samuel
authors.initials: S
authors.lastname: Malamba
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hladik
authors.forename: Arthur
authors.initials: A
authors.lastname: Reingold
authors.forename: Flora
authors.initials: F
authors.lastname: Banage
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
authors.forename: George
authors.initials: G
authors.lastname: Rutherford
authors.forename: Derrick
authors.initials: D
authors.lastname: Mimbe
authors.forename: Esau
authors.initials: E
authors.lastname: Nzaro
authors.forename: Robert
authors.initials: R
authors.lastname: Downing
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
mesh_terms: 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