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

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. ThPeC7607

BACKGROUND: In sub-Saharan Africa HIV and malaria are among the most important diseases in terms of morbidity and mortality. Understanding if and how the two infections interact is important for their control. We conducted several studies aimed at investigating the presence of a potential association between HIV and malaria.

METHODS: During the period 1996-2000, we conducted both epidemiological and immunological studies at Lacor Hospital, North Uganda: an HIV sero-survey among 699 adult patients admitted to the medical ward; an unmatched hospital-based case-control study involving 36 clinical malaria cases and 134 controls among whom the exposure to HIV was investigated; and a immunophenotype analysis among 23 HIV- Africans and Italians living in North Uganda and 30 HIV- Africans and Italians living in Italy.

RESULTS: The sero-survey shows a very high HIV prevalence among patients admitted for malaria (48.8%, 95% CI: 32.9%-64.9%) when compared to that estimated for the general population living in the hospital's catchment area (17.8% in 1996-1997), suggesting the presence of an association between HIV and malaria. This hypothesis was tested through the case control study, which showed a significant association between HIV and clinical malaria (OR=3.61, 95% CI: 1.04-12.52). Finally, immunological results showed a similar pattern of immune activation in healthy African residents, both Italians and Ugandans. This immune activation disappears in Ugandans living in Italy, suggesting that environmental factors, such as parasitic infection (e.g., malaria), influence the abnormal immune activation that has repeatedly been postulated to be involved in the pathogenesis of African HIV infection.

CONCLUSIONS: The combined results suggest an association between HIV and malaria that could be very important for public health in sub-Saharan Africa. The role of other concurrent infections highly diffused in this area should also be investigated.

Presenting author: Silvia Declich

1Laboratory of Epidemiology and Biostatistics, Istituto Superiore di Sanità, Lab. Epidemiology and Biostatistics, Istituto Superiore di Sanità, Viale regina Elena 299, 00161 - Rome, Italy.

2Chair of Immunology, University of Milan, Milan, Italy.

3St. Mary's Hospital Lacor, Gulu, Uganda.

4Infectious Diseases Unit, Circolo di Busto Arsizio Hospital, Varese, Italy.

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