title: HIV-malaria co-infection: effects of malaria on the prevalence of HIV in East sub-Saharan Africa.
abstract: OBJECTIVE
  To examine the association between malaria and HIV prevalence in East sub-Saharan Africa.
  
  
  METHODS
  Using large nationally representative samples of 19,735 sexually active adults from the 2003-04 HIV/AIDS indicator surveys conducted in Kenya, Malawi and Tanzania, and the atlas malaria project, we analysed the relationship between malaria and HIV prevalence adjusting for important socioeconomic and biological cofactors.
  
  
  RESULTS
  In adjusted models, individuals who live in areas with high Plasmodium falciparum parasite rate (PfPR > 0.42) had increased estimated odds of being HIV positive than individuals who live in areas with low P. falciparum parasite rate (PfPR ≤ 0.10) [men: estimated odds ratio (OR) 2.24, 95% confidence interval (CI) 1.62-3.12; women: estimated OR 2.44, 95% CI 1.85-3.21].
  
  
  CONCLUSIONS
  This is the first study to report malaria as a risk factor of concurrent HIV infection at the population level. According to our results, individuals who live in areas with high P. falciparum parasite rate have about twice the risk of being HIV positive compared with individuals who live in areas with low P. falciparum parasite rate. Our work emphasizes the need for field studies focused on quantifying the interaction among parasitic infections and risk of HIV infection, and studies to explore the impact of control interventions. Programmes focused on reducing malaria transmission will be important to address, especially in HIV-infected individuals.
authors.affiliation: Department of Biology, University of Kentucky, Lexington, KY 40506, USA. dfcuad2@uky.edu
authors.forename: Diego F
authors.initials: DF
authors.lastname: Cuadros
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Branscum
authors.forename: Philip H
authors.initials: PH
authors.lastname: Crowley
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D060085:Coinfection; D016208:Databases, Factual; D005260:Female; D040362:Geographic Information Systems; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008288:Malaria / Q000150:complications / Q000453:epidemiology*; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010963:Plasmodium falciparum; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult