title: HIV infection and the incidence of malaria among HIV-exposed children from Tanzania.
abstract: OBJECTIVE
  To determine whether human immunodeficiency virus (HIV) infection is associated with increased risk of malaria incidence and recurrence in children.
  
  
  METHODS
  Newborn infants of HIV-infected mothers were enrolled at 6 weeks and followed for 2 years. HIV status was assessed by enzyme-linked immunosorbant assay and confirmed by HIV DNA polymerase chain reaction. Malaria was defined as (1) physician-diagnosed clinical malaria; (2) probable malaria, in which laboratory testing is requested for parasitemia; and (3) blood smear-confirmed malaria. Cox proportional hazards models estimated hazard ratios (HRs) for development of first and second malaria episodes, and generalized estimating equation models estimated malaria rate differences per 100-child-years in relation to time-updated HIV status.
  
  
  RESULTS
  Child HIV infection was associated with clinical (HR, 1.34; 95% confidence interval [CI], 1.12-1.61), probable (HR, 1.47; 95% CI, 1.19-1.81), and confirmed (HR, 1.67; 95% CI, 1.18-2.36) malaria episodes. Per 100 child-years, HIV-infected children experienced 88 (95% CI, 65-113), 36 (95% CI, 19-53), and 20 (95% CI, 9-31) more episodes of clinical, probable, and confirmed malaria episodes, respectively, than HIV-uninfected children. Among children with ≥1 malaria episodes, those with HIV infection developed second clinical (HR, 1.28; 95% CI, 1.04-1.57), probable (HR, 1.60; 95% CI, 1.26-2.14), and confirmed (HR, 2.27; 95% CI, 1.06-3.89) malaria sooner than HIV-uninfected children.
  
  
  CONCLUSIONS
  HIV infection is a risk factor for the development of malaria. Proactive malaria disease prevention and treatment is warranted for all children, particularly those with HIV infection in settings of coendemicity.
authors.affiliation: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. aezeamam@hsph.harvard.edu
authors.forename: Amara E
authors.initials: AE
authors.lastname: Ezeamama
authors.forename: Donna
authors.initials: D
authors.lastname: Spiegelman
authors.forename: Ellen
authors.initials: E
authors.lastname: Hertzmark
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: Karim P
authors.initials: KP
authors.lastname: Manji
authors.forename: Christopher
authors.initials: C
authors.lastname: Duggan
authors.forename: Roland
authors.initials: R
authors.lastname: Kupka
authors.forename: Melanie W
authors.initials: MW
authors.lastname: Lo
authors.forename: James O
authors.initials: JO
authors.lastname: Okuma
authors.forename: Rodrick
authors.initials: R
authors.lastname: Kisenge
authors.forename: Said
authors.initials: S
authors.lastname: Aboud
authors.forename: Wafaie W
authors.initials: WW
authors.lastname: Fawzi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D000962:Antimalarials / Q000008:administration & dosage; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D018512:Parasitemia / Q000175:diagnosis / Q000469:parasitology; D010961:Plasmodium / Q000302:isolation & purification; D011247:Pregnancy; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000962:Antimalarials