title: HIV infection, malnutrition, and invasive bacterial infection among children with severe malaria.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) infection, malnutrition, and invasive bacterial infection (IBI) are reported among children with severe malaria. However, it is unclear whether their cooccurrence with falciparum parasitization and severe disease happens by chance or by association among children in areas where malaria is endemic.
  
  
  METHODS
  We examined 3068 consecutive children admitted to a Kenyan district hospital with clinical features of severe malaria and 592 control subjects from the community. We performed multivariable regression analysis, with each case weighted for its probability of being due to falciparum malaria, using estimates of the fraction of severe disease attributable to malaria at different parasite densities derived from cross-sectional parasitological surveys of healthy children from the same community.
  
  
  RESULTS
  HIV infection was present in 133 (12%) of 1071 consecutive parasitemic admitted children (95% confidence interval [CI], 11%-15%). Parasite densities were higher in HIV-infected children. The odds ratio for admission associated with HIV infection for admission with true severe falciparum malaria was 9.6 (95% CI, 4.9-19); however, this effect was restricted to children aged 1 year. Malnutrition was present in 507 (25%) of 2048 consecutive parasitemic admitted children (95% CI, 23%-27%). The odd ratio associated with malnutrition for admission with true severe falciparum malaria was 4.0 (95% CI, 2.9-5.5). IBI was detected in 127 (6%) of 2048 consecutive parasitemic admitted children (95% CI, 5.2%-7.3%). All 3 comorbidities were associated with increased case fatality.
  
  
  CONCLUSIONS
  HIV, malnutrition and IBI are biologically associated with severe disease due to falciparum malaria rather than being simply alternative diagnoses in co-incidentally parasitized children in an endemic area.
authors: Centre for Geographic Medicine Research, Kilifi, Kenya. jberkley@kilifi.kemri-wellcome.org
authors: James A
authors: JA
authors: Berkley
authors: Philip
authors: P
authors: Bejon
authors: Tabitha
authors: T
authors: Mwangi
authors: Samson
authors: S
authors: Gwer
authors: Kathryn
authors: K
authors: Maitland
authors: Thomas N
authors: TN
authors: Williams
authors: Shebe
authors: S
authors: Mohammed
authors: Faith
authors: F
authors: Osier
authors: Samson
authors: S
authors: Kinyanjui
authors: Greg
authors: G
authors: Fegan
authors: Brett S
authors: BS
authors: Lowe
authors: Mike
authors: M
authors: English
authors: Norbert
authors: N
authors: Peshu
authors: Kevin
authors: K
authors: Marsh
authors: Charles R J C
authors: CR
authors: Newton
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology*; D002675:Child, Preschool; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007630:Kenya; D016778:Malaria, Falciparum / Q000150:complications*; D044342:Malnutrition / Q000453:epidemiology*