title: Increased severity and mortality in adults co-infected with malaria and HIV in Maputo, Mozambique: a prospective cross-sectional study.
abstract: BACKGROUND
  Co-infection with falciparum malaria and HIV-1 increases the severity and mortality of both infections in unstable malaria-transmission areas. In contrast, in stable transmission areas, HIV co-infection increases the severity of both infections but has not been found to influence malaria mortality.
  
  
  METHODS
  In a prospective cross-sectional study, clinical and laboratory data were consecutively collected for all adults admitted with fever and/or suspected malaria to the medical department of the Central Hospital of Maputo, Mozambique, during two malaria seasons from January 2011. Malaria and HIV PCRs were performed, and risk factors for fatal outcomes were analysed. The impact of HIV on the clinical presentation and mortality of malaria was assessed.
  
  
  RESULTS
  A total of 212 non-pregnant adults with fever and/or suspected malaria and 56 healthy controls were included in the study. Of the 131 patients with confirmed falciparum malaria, 70 were co-infected with HIV-1. The in-hospital mortality of the co-infected patients was 13.0% (9/69) compared with 1.7% (1/59) in the patients without HIV (p = 0.018). Malaria severity (p = 0.016) and co-infection with HIV (p = 0.064) were independent risk factors for death although the association with HIV did not reach statistical significance. The co-infected patients had significantly more frequent respiratory distress, bleeding disturbances, hypoglycaemia, liver and renal failure and high malaria parasitemia compared with the patients with malaria alone.
  
  
  CONCLUSIONS
  HIV co-infection is associated with increased disease severity in and mortality from malaria in an area of stable malaria transmission. This finding was not observed earlier and should motivate doctors working in malaria-endemic areas to consider early HIV testing and a closer follow-up of patients with malaria and HIV co-infection.
authors: Department of Medicine, Stavanger University Hospital, Stavanger, Norway ; Department of Medicine, The Central Hospital of Maputo, Maputo, Mozambique ; The Faculty of Medicine, The University of Bergen, Bergen, Norway.
authors: Aase
authors: A
authors: Berg
authors: Department of Medicine, The Central Hospital of Maputo, Maputo, Mozambique.
authors: Sam
authors: S
authors: Patel
authors: Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors: Pål
authors: P
authors: Aukrust
authors: Department of Medicine, The Central Hospital of Maputo, Maputo, Mozambique.
authors: Catarina
authors: C
authors: David
authors: Department of Medicine, The Central Hospital of Maputo, Maputo, Mozambique.
authors: Miguel
authors: M
authors: Gonca
authors: Department of Virology, The Norwegian Institute of Public Health, Oslo, Norway.
authors: Einar S
authors: ES
authors: Berg
authors: Department of Research, Stavanger University Hospital, Stavanger, Norway.
authors: Ingvild
authors: I
authors: Dalen
authors: The Faculty of Medicine, The University of Bergen, Bergen, Norway.
authors: Nina
authors: N
authors: Langeland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060085:Coinfection / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D016778:Malaria, Falciparum / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009073:Mozambique / Q000453:epidemiology; D018512:Parasitemia / Q000150:complications / Q000453:epidemiology / Q000401:mortality; D010963:Plasmodium falciparum / Q000302:isolation & purification; D011446:Prospective Studies; D012307:Risk Factors; D055815:Young Adult