title: Association of HIV-Induced Immunosuppression and Clinical Malaria in Nigerian Adults.
abstract: Despite the growing body of evidence on the interaction between HIV and malaria in sub-Saharan Africa, there is a dearth of data on clinical malaria in HIV-infected patients in Nigeria. We determined the burden of clinical malaria in HIV-infected adult Nigerians and further investigated the association between their immunological status and the rates of clinical malaria. Ninety seven antiretroviral treatment-naïve HIV-infected adults were enrolled in a cross-sectional study from August to December, 2009. The participants had a complete clinical evaluation, thick and thin blood films for malaria parasites and CD4 cell count quantification. Clinical malaria was defined as having fever (temperature ≥ 37.5°C or history of fever within 48 hours) and a malaria parasite density above the median value obtained for subjects with co-existing fever and parasitaemia. Clinical malaria was diagnosed in 10 out of 97 patients (10.3%). Lower CD4 cell counts were associated with increasing rates of clinical malaria which was 0% at CD4 cell count of ≥ 500, 2.6% at 200-499 and 30% at <200 cells/µL (χ(2) = 18.3, p = 0.0001). This association remained significant after controlling for other factors in a multivariate analysis (AOR=22.98, 95% C.I: 2.62-20.14, p = 0.005). An inverse relationship between CD4 cell count and parasite density was demonstrated (regression co-efficient = - 0.001, p = 0.0002). More aggressive malaria control measures are highly needed in severely immunosuppressed HIV-infected patients.
authors.affiliation: Department of Medicine, University of Nigeria, Enugu Campus, Nigeria.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Iroezindu
authors.forename: Emmanuel I
authors.initials: EI
authors.lastname: Agaba
authors.forename: Comfort A
authors.initials: CA
authors.lastname: Daniyam
authors.forename: Edith N
authors.initials: EN
authors.lastname: Okeke
authors.forename: Oche O
authors.initials: OO
authors.lastname: Agbaji
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Agaba
authors.forename: Godwin E
authors.initials: GE
authors.lastname: Imade
authors.forename: John A
authors.initials: JA
authors.lastname: Idoko
keywords: Adults; Clinical malaria; HIV; Immunosuppression