title: Human immunodeficiency virus infection and cerebral malaria in children in Uganda: a case-control study.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV)-1 infection increases the burden of malaria by increasing susceptibility to infection and decreasing the response to malarial treatment. HIV-1 has also been found to suppress the immune system and predispose to severe forms of malaria in adults. There is still a paucity of data on the association between HIV-1 infection and cerebral malaria in children. The aim of this study was to determine whether HIV-1 infection is a risk factor for cerebral malaria in children.
  
  
  METHODS
  We conducted an unmatched case-control study, in which 100 children with cerebral malaria were compared with 132 with uncomplicated malaria and 120 with no malaria. In stratified analyses we estimated odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age.
  
  
  RESULTS
  HIV-1 infection was present in 9% of children with cerebral malaria compared to 2.3% in uncomplicated malaria (age-adjusted odds ratio (aOR) 5.94 (95% confidence interval (CI) 1.36-25.94, p = 0.012); and 2.5% in children with no malaria (aOR 3.85 (95% CI0.99-14.93, p = 0.037). The age-adjusted odds of being HIV-positive among children with cerebral malaria compared to the control groups (children with uncomplicated malaria and no malaria) was 4.98 (95% CI 1.54-16.07), p-value = 0.003.
  
  
  CONCLUSIONS
  HIV-1 infection is associated with clinical presentation of cerebral malaria in children. Clinicians should ensure that children diagnosed with HIV infection are initiated on cotrimoxazole prophylaxis as soon as the diagnosis is made and caretakers counselled on the importance of adherence to the cotrimoxazole towards reducing the risk of acquiring P.falciparum malaria and associated complications such as cerebral malaria. Other malaria preventive measures such as use of insecticide-treated mosquito nets should also be emphasized during counselling sessions.
authors.affiliation: Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda. imani9p@yahoo.com
authors.forename: Peace D
authors.initials: PD
authors.lastname: Imani
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
authors.forename: Justus
authors.initials: J
authors.lastname: Byarugaba
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
mesh_terms: D000740:Anemia / Q000453:epidemiology; D000962:Antimalarials / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004198:Disease Susceptibility; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006679:HIV Seropositivity; D015497:HIV-1; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D016779:Malaria, Cerebral / Q000188:drug therapy / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D018512:Parasitemia / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology
chemical_list: D000962:Antimalarials