Impact of HIV-1 infection on the hematological recovery after clinical malaria.
BACKGROUND
Anemia is the most frequent cytopenia in HIV-infected individuals and is often associated with malaria.


OBJECTIVE
To assess the impact of HIV-1 on the hematological recovery after a clinical malaria episode.


METHODS
In Ndola, Zambia, a region with high malaria and HIV prevalence, hemoglobin (Hb) was measured in 634 malaria patients 14 and 45 days after antimalarial treatment. Risk factors for hematological recovery were analyzed in a multivariate linear regression model.


RESULTS
At enrollment, HIV-1-infected malaria patients had lower Hb compared with HIV-1 uninfected (122.7 vs 136.0 g/L; P < 0.001). In both groups, mean Hb was significantly lower at day 14 posttreatment than day 0 (P < 0.0001) and significantly higher at day 45 than at day 14 (HIV-1 negative: P = 0.0001; HIV-1 infected: P = 0.005). HIV-1 was a risk factor for a larger Hb decrease until day 14 (P < 0.001) and slower recovery until day 45 (P = 0.048). When considering the whole 45-day follow-up period, mean Hb increased in the HIV-1-negative group (+3.54 g/L; 95% confidence interval: 1.37 to 5.70; P = 0.001) but not in the HIV-1-infected group (-0.72 g/L; 95% confidence interval: -3.85 to +2.40; P = 0.64). HIV-1 infection as such (P < 0.0001), not CD4 cell count (P = 0.46), was an independent risk factor for a slower hematological recovery.


CONCLUSIONS
HIV-1-infected malaria patients had a slower hematological recovery after successful parasite clearance. Malaria preventive measures should be targeted to this high-risk group.
Van Geertruyden
Jean-Pierre
JP
Department of Parasitology, and Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. jpvangeertruyden@itg.be
Mulenga
Modest
M
Chalwe
Victor
V
Michael
Nambozi
N
Moerman
Filip
F
Mukwamataba
Doreen
D
Colebunders
Robert
R
D'alessandro
Umberto
U
D000740:Anemia / Q000097:blood* / Q000469:parasitology; D000818:Animals; D000962:Antimalarials / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology / Q000821:virology; D015497:HIV-1; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D015999:Multivariate Analysis; D010963:Plasmodium falciparum; D012307:Risk Factors; D016896:Treatment Outcome; D015024:Zambia
D000962:Antimalarials; D006454:Hemoglobins