title: Presence of Plasmodium falciparum DNA in Plasma Does Not Predict Clinical Malaria in an HIV-1 Infected Population.
abstract: BACKGROUND
  HIV-1 and Plasmodium falciparum malaria cause substantial morbidity in Sub-Saharan Africa, especially as co-infecting pathogens. We examined the relationship between presence of P. falciparum DNA in plasma samples and clinical malaria as well as the impact of atazanavir, an HIV-1 protease inhibitor (PI), on P. falciparum PCR positivity.
  
  
  METHODS
  ACTG study A5175 compared two NNRTI-based regimens and one PI-based anti-retroviral (ARV) regimen in antiretroviral therapy naïve participants. We performed nested PCR on plasma samples for the P. falciparum 18s rRNA gene to detect the presence of malaria DNA in 215 of the 221 participants enrolled in Blantyre and Lilongwe, Malawi. We also studied the closest sample preceding the first malaria diagnosis from 102 persons with clinical malaria and randomly selected follow up samples from 88 persons without clinical malaria.
  
  
  RESULTS
  PCR positivity was observed in 18 (8%) baseline samples and was not significantly associated with age, sex, screening CD4+ T-cell count, baseline HIV-1 RNA level or co-trimoxazole use within the first 8 weeks. Neither baseline PCR positivity (p = 0.45) nor PCR positivity after initiation of antiretroviral therapy (p = 1.0) were significantly associated with subsequent clinical malaria. Randomization to the PI versus NNRTI ARV regimens was not significantly associated with either PCR positivity (p = 0.5) or clinical malaria (p = 0.609). Clinical malaria was associated with a history of tuberculosis (p = 0.006) and a lower BMI (p = 0.004).
  
  
  CONCLUSIONS
  P. falciparum DNA was detected in 8% of participants at baseline, but was not significantly associated with subsequent development of clinical malaria. HIV PI therapy did not decrease the prevalence of PCR positivity or incidence of clinical disease.
authors.affiliation: School of Medicine, University of California San Diego, San Diego, California, United States of America.
authors.forename: Marika
authors.initials: M
authors.lastname: Orlov
authors.affiliation: Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Smeaton
authors.affiliation: Johns Hopkins University Research Project, Blantyre, Malawi.
authors.forename: Johnstone
authors.initials: J
authors.lastname: Kumwenda
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America; University of North Carolina Project, Lilongwe, Malawi.
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.affiliation: School of Medicine, University of Colorado, Aurora, Colorado, United States of America.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
authors.affiliation: School of Medicine, University of California San Diego, San Diego, California, United States of America.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Schooley
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016054:DNA, Protozoan / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000150:complications* / Q000469:parasitology / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008288:Malaria / Q000097:blood* / Q000150:complications* / Q000469:parasitology / Q000821:virology; D008297:Male; D008875:Middle Aged; D018512:Parasitemia / Q000097:blood / Q000453:epidemiology / Q000469:parasitology; D010963:Plasmodium falciparum / Q000378:metabolism*; D015995:Prevalence; D055815:Young Adult
chemical_list: D016054:DNA, Protozoan