14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. ThPeC7604

BACKGROUND: HIV-infection and malaria are leading public health problems in sub-Saharan Africa. The interaction between these two conditions is poorly understood and difficult to unravel in immune populations where parasitaemia and HIV-associated fever commonly co-exist.

METHODS: We took the opportunity to investigate the relationship between HIV and falciparum malaria in a non-immune population in Hlabisa district, Kwazulu-Natal during an epidemic of malaria between December 1999 and April 2000. Systematic case-finding of malaria was undertaken at Hlabisa hospital and four community clinics at the epicentre of the outbreak. All acute fever cases were assessed with a rapid malaria slide test, with positive tests subsequently confirmed by microscopy along with anonymised HIV-testing of a blood spot collected onto filter paper.

RESULTS: HIV seroprevalence was 29% in the 605 adult malaria cases. Overall case-fatality was 4.3%. HIV was disproportionately represented in the severe cases (defined according to WHO criteria). In a logistic regression model the OR's for HIV associated with hospital admission, severe disease and death were 1.4 (95%CI:1.0-2.0), 3.9 (2.3-6.8) and 10.9 (2.2-55.3) respectively. HIV was the most important risk factor for severe disease in this non-immune adult population.

CONCLUSIONS: Increased emphasis on prevention of malaria is necessary in populations with a high prevalence of HIV. In addition investigation of HIV/P.falciparum co-infection may offer new insights into the anti-parasite/anti-toxic immune response.

Presenting author: Neil French

1Hlabisa General Hospital, South Africa.

2Liverpool School of Tropical Medicine, Liverpool, United Kingdom.

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