Imported malaria in HIV-infected patients enrolled in the ANRS CO4 FHDH study.
BACKGROUND
To describe episodes of imported malaria in human immunodeficiency virus type 1-infected patients and to study the risk factors for severe Plasmodium falciparum malaria.


METHODS
Patients enrolled in the French Hospital Database on HIV who were diagnosed with a first episode of malaria between 1996 and 2003 were included. The severity of P. falciparum imported malaria was graded with World Health Organization criteria. Geographic areas were classified according to P. falciparum chemoresistance. Risk factors for severe malaria were identified with logistic regression.


RESULTS
We studied 190 patients infected by P. falciparum in 178 cases. All but four of the patients were infected in sub-Saharan Africa, and half were returning from a country with a high P. falciparum chloroquine resistance. Their median age was 37.5 years, and 57% came from a country endemic with malaria. The median CD4 cell count was 299/mm, and the median plasma human immunodeficiency virus type 1 RNA load was 4.5 log10 copies/mL. Sixty-five (36.5%) episodes of P. falciparum malaria were severe. Severe imported malaria was associated with CD4 cells/mm <350 (odds ratio = 2.58; 95% confidence interval: 1.19 to 5.57). The risk of severe malaria was lower in patients returning from a country with a high prevalence of chemoresistance (odds ratio = 0.50; 95% confidence interval: 0.25 to 0.99).


CONCLUSIONS
Severe imported malaria in human immunodeficiency virus type 1-infected patients is associated with decreased CD4 cell count. The risk seems lower when P. falciparum infection was acquired in areas of high prevalence of chemoresistance.
Mouala
Christian
C
INSERM, U720, Paris, F-75013 France. cmouala@ccde.chups.jussieu.fr
Houzé
Sandrine
S
Guiguet
Marguerite
M
Abboud
Philippe
P
Pialoux
Gilles
G
Viget
Nathalie
N
Costagliola
Dominique
D
Matheron
Sophie
S
D000328:Adult; D000352:Africa, Northern; D018791:CD4 Lymphocyte Count; D018562:Disease Transmission, Infectious; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012307:Risk Factors; D014195:Travel; D019562:Viral Load