[ThPeC7602] Increase in severe malaria in HIV-positive adults in South Africa

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Increase in severe malaria in HIV-positive adults in South Africa

[AUTHOR(S):] C. Cohen, L. Dini, J. Frean, H. Crewe Brown¹, A. Karstaedt, N. Govender, J. Thomas, D. Hlatshwayo, J. Galpin²

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. ThPeC7602

BACKGROUND: HIV and malaria are common infectious diseases in sub-Saharan Africa. Greater parasite densities and rates of clinical malaria have been demonstrated in HIV-positive patients from Uganda. Our aim was to determine whether HIV-positivity affects clinical severity and parasitaemia in adult South African patients with falciparum malaria.

METHODS: A prospective cohort study was conducted at Chris Hani Baragwanath Hospital from January to June 2001/2002. All adult patients admitted with falciparum malaria were approached for inclusion in the study. Study participants were tested for HIV status and CD4+ count. Patients were followed up for the duration of hospitalisation. Features of severe malaria as defined by WHO criteria were noted. HIV-positive patients were stratified by CD4+ cell count and clinically staged. All malaria smears were reviewed. HIV-positive and -negative groups were compared. Ethical approval was obtained.

RESULTS: 253 patients were enrolled in the study during 2001. 31% of patients were HIV-positive. HIV-positive patients had significantly increased rates of severe and complicated malaria when compared to HIV-negative patients (15/79 14% vs. 14/174 8% p=0.02). Patients with CD4+ cell count below 200 had increased rates of severe malaria when compared to those with CD4+ cell count above 200 and HIV-negative (p=0.05). HIV-positive patients had significantly increased rates of renal failure, severe anaemia and DIC. The increase in severe malaria was more marked in South African patients with no immunity to malaria than in patients from malaria-endemic areas. Data collected during the malaria season of 2002 will also be presented.

CONCLUSIONS: HIV-positive South African patients have an increased risk of severe malaria. This risk increases as CD4+ cell count decreases. This has important public health implications.

Presenting author: Cheryl Cohen

1National Health Laboratory Services and University of the Witwatersrand, 12 Jacaranda Lodge, 4 Main Rd Melville, 2092, Johannesburg, South Africa.

2University of the Witwatersrand, Johannesburg, South Africa.

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