November 01, 2012
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HIV increased mortality from severe malaria

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Patients with severe malaria in Mozambique, Africa, who also have HIV appear to have higher parasite burden, more complications and a higher fatality rate, according to recent data.

Researchers from Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand, conducted a prospective study on the effects of HIV on severe malaria. The study was part of a clinical trial comparing artesunate and quinine.

“Severe malaria and HIV coinfection are common in settings with both high malaria transmission intensity and high HIV-1 seroprevalence,” the researchers wrote. “Various interactions between malaria and HIV have been described, and the diseases negatively affect their reciprocal courses. However, only few studies address the effects of HIV infection on severe morbidity and mortality in African children, who carry the highest burden of disease.”

Among patients with severe malaria, the HIV seroprevalence was 11% in children aged younger than 15 years and 72% in adults. Compared with non-coinfected children, children with HIV and malaria had more severe acidosis, anemia and respiratory distress, as well as higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2. Mortality was 26% among coinfected children vs. 9% in uninfected children.

“Higher case fatality and more frequent complications warrant more intense monitoring and a low threshold for additional investigations to diagnose concomitant invasive bacterial infections, including chest X-ray, blood culture and lumbar puncture with CSF examination,” the researchers wrote. “Since concomitant pneumonia, sepsis and severe anemia are common, prompt parenteral antimalarial and antibiotic treatment, and availability of supportive treatments are of extra importance in this group.”

Disclosure: The researchers report no relevant financial disclosures.