title: Effect of HIV-1 Serostatus on the Prevalence of Asymptomatic Plasmodium falciparum Parasitemia Among Children Less Than 5 Years of Age in Benin City, Nigeria.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) infection and Plasmodium falciparum malaria are 2 of the gravest health threats in sub-Saharan Africa. Multiple repeat infections with the malaria parasite as seen in endemic areas are necessary to develop specific malaria immunity. HIV is an immunosuppressive virus and in children aged <5 years, development of malaria-specific immunity may be impaired and malaria parasite clearance in theory will be delayed; hence the predisposition to increased incidence of asymptomatic malaria or severe malaria. This cross-sectional study was carried out to examine associations between immunosuppression and asymptomatic malaria parasitemia (ASMP) in HIV-infected children aged <5 years in Benin City.
  
  
  METHODS
  One hundred seventy-nine asymptomatic HIV-1-positive and 179 age- and sex-matched HIV-1-negative children aged <5 years were recruited. The malaria parasite was determined by Giemsa-stained blood film by certified microscopy while concomitant CD4(+) count was estimated in the HIV-infected children.
  
  
  RESULTS
  The prevalence of ASMP in those who were HIV-infected of 34.1% was significantly higher than 17.3% in the HIV uninfected (P = .001). The prevalence of ASMP was highest (59.3%) among subjects who were severely immunosuppressed (CDC immunologic category 3). The prevalence of ASMP significantly increased with advanced immune disease in the subjects (P = .011). Severe (World Health Organization) clinical staging was also significantly associated with increased prevalence of ASMP (P = .031). The prevalence of ASMP is significantly higher among subjects not receiving cotrimoxazole, associated with threefold risk of having ASMP (P = .003: odds ratio = 3.5).
  
  
  CONCLUSIONS
  ASMP is more common in HIV-positive children aged <5 years and is significantly associated with declining CD4(+) T-cell count and severe clinical disease. There is a need for integration of HIV- and malaria-control programs for stronger case management. Malaria-control programs may consider malaria prevention interventions and cotrimoxazole prophylaxis for preschool children who are HIV-infected and living in malaria-endemic regions.
authors.affiliation: Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
authors.forename: Ikechukwu R
authors.initials: IR
authors.lastname: Okonkwo
authors.affiliation: Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Ibadin
authors.affiliation: Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
authors.forename: Austin I
authors.initials: AI
authors.lastname: Omoigberale
authors.affiliation: Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
authors.forename: Wilson E
authors.initials: WE
authors.lastname: Sadoh
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage; D058345:Asymptomatic Infections / Q000453:epidemiology*; D018890:Chemoprevention / Q000379:methods; D002675:Child, Preschool; D060085:Coinfection / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000276:immunology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007108:Immune Tolerance; D016867:Immunocompromised Host; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D016017:Odds Ratio; D018512:Parasitemia / Q000453:epidemiology*; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage
chemical_list: D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: HIV; asymptomatic malaria parasitemia; immunosuppression; malaria; preschool; prevalence