title: Effect of HIV and malaria parasites co-infection on immune-hematological profiles among patients attending anti-retroviral treatment (ART) clinic in Infectious Disease Hospital Kano, Nigeria.
abstract: BACKGROUND
  Human immunodeficiency virus (HIV) and malaria co-infection may present worse health outcomes in the tropics. Information on HIV/malaria co-infection effect on immune-hematological profiles is critical for patient care and there is a paucity of such data in Nigeria.
  
  
  OBJECTIVE
  To evaluate immune-hematological profiles among HIV infected patients compared to HIV/malaria co-infected for ART management improvement.
  
  
  METHODS
  This was a cross sectional study conducted at Infectious Disease Hospital, Kano. A total of 761 consenting adults attending ART clinic were randomly selected and recruited between June and December 2015. Participants' characteristics and clinical details including two previous CD4 counts were collected. Venous blood sample (4ml) was collected in EDTA tube for malaria parasite diagnosis by rapid test and confirmed with microscopy. Hematological profiles were analyzed by Sysmex XP-300 and CD4 count by Cyflow cytometry. Data was analyzed with SPSS 22.0 using Chi-Square test for association between HIV/malaria parasites co-infection with age groups, gender, ART, cotrimoxazole and usage of treated bed nets. Mean hematological profiles by HIV/malaria co-infection and HIV only were compared using independent t-test and mean CD4 count tested by mixed design repeated measures ANOVA. Statistical significant difference at probability of <0.05 was considered for all variables.
  
  
  RESULTS
  Of the 761 HIV infected, 64% were females, with a mean age of ± (SD) 37.30 (10.4) years. Prevalence of HIV/malaria co-infection was 27.7% with Plasmodium falciparum specie accounting for 99.1%. No statistical significant difference was observed between HIV/malaria co-infection in association to age (p = 0.498) and gender (p = 0.789). A significantly (p = 0.026) higher prevalence (35.2%) of co-infection was observed among non-ART patients compared to (26%) ART patients. Prevalence of co-infection was significantly lower (20.0%) among cotrimoxazole users compared to those not on cotrimoxazole (37%). The same significantly lower co-infection prevalence (22.5%) was observed among treated bed net users compared to those not using treated bed nets (42.9%) (p = 0.001). Out of 16 hematology profiles evaluated, six showed significant difference between the two groups (i) packed cell volume (p = <0.001), (ii) mean cell volume (p = 0.005), (iii) mean cell hemoglobin concentration (p = 0.011), (iv) absolute lymphocyte count (p = 0.022), (v) neutrophil percentage count (p = 0.020) and (vi) platelets distribution width (p = <0.001). Current mean CD4 count cell/μl (349±12) was significantly higher in HIV infected only compared to co-infected (306±17), (p = 0.035). A significantly lower mean CD4 count (234.6 ± 6.9) was observed among respondents on ART compared to non-ART (372.5 ± 13.2), p<0.001, mean difference = -137.9).
  
  
  CONCLUSIONS
  The study revealed a high burden of HIV and malaria co-infection among the studied population. Co-infection was significantly lower among patients who use treated bed nets as well as cotrimoxazole chemotherapy and ART. Six hematological indices differed significantly between the two groups. Malaria and HIV co-infection significantly reduces CD4 count. In general, to achieve better management of all HIV patients in this setting, diagnosing malaria, prompt antiretroviral therapy, monitoring CD4 and some hematology indices on regular basis is critical.
authors.affiliation: Family Health International-360 Plot 1073-A1 GODAB Plaza, Area 3 Garki-Abuja, Nigeria.|Biological Science Department, Bayero University, Kano, Nigeria.
authors.forename: Feyisayo Ebenezer
authors.initials: FE
authors.lastname: Jegede
authors.affiliation: Biological Science Department, Bayero University, Kano, Nigeria.
authors.forename: Tinuade Ibijoke
authors.initials: TI
authors.lastname: Oyeyi
authors.affiliation: Department of Public Health, Penang Medical College, George Town, Penang, Malaysia.
authors.forename: Surajudeen Abiola
authors.initials: SA
authors.lastname: Abdulrahman
authors.affiliation: LabTrail, Global LLC, Smyrna DE, United States of America.
authors.forename: Henry Akwen
authors.initials: HA
authors.lastname: Mbah
authors.affiliation: Family Health International-360 Plot 1073-A1 GODAB Plaza, Area 3 Garki-Abuja, Nigeria.
authors.forename: Titilope
authors.initials: T
authors.lastname: Badru
authors.affiliation: Family Health International-360 Plot 1073-A1 GODAB Plaza, Area 3 Garki-Abuja, Nigeria.
authors.forename: Chinedu
authors.initials: C
authors.lastname: Agbakwuru
authors.affiliation: Family Health International-360 Plot 1073-A1 GODAB Plaza, Area 3 Garki-Abuja, Nigeria.
authors.forename: Oluwasanmi
authors.initials: O
authors.lastname: Adedokun
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D000962:Antimalarials / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D060085:Coinfection / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006678:HIV / Q000187:drug effects; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008288:Malaria / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000453:epidemiology; D010961:Plasmodium / Q000187:drug effects; D010963:Plasmodium falciparum / Q000187:drug effects; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D044966:Anti-Retroviral Agents; D000962:Antimalarials; D015662:Trimethoprim, Sulfamethoxazole Drug Combination