HIV‐1 Immune Suppression and Antimalarial Treatment Outcome in Zambian Adults with Uncomplicated Malaria
Departments of 1Parasitology, 2Microbiology, and 3Clinical Sciences, Institute of Tropical Medicine, and 4University of Antwerp, Antwerp, Belgium; 5Department of Clinical Sciences, Tropical Disease Research Center, Ndola, Zambia
Background.
Human immunodeficiency virus (HIV)–1 infected adults with low CD4 cell count have a higher risk of malaria infection and clinical malaria. We assessed the influence that HIV‐1 immune suppression has on the efficacy of antimalarial treatment in adults with uncomplicated malaria
Methods.This clinical trial included 971 Zambian adults with uncomplicated malaria. Patients were tested for HIV‐1, and, if positive, a CD4 cell count was assessed. The primary outcome was recurrent parasitemia corrected by molecular genotyping within 45 days after treatment.
Results.HIV‐1 infection was detected in 33% (320/971) of adult patients with malaria. Treatment failure was not associated with HIV‐1 infection (relative risk [RR], 1.12 [95% confidence interval {CI}, 0.82–1.53]; 
). HIV‐1–infected patients with a CD4 cell count <300 cells/μL had an increased risk of recurrent parasitemia, compared with those with a CD4 cell count 
300 cells/μL (RR, 2.24 [95% CI, 1.20–4.14]; 
). After genotyping, the risk of recrudescence was higher in HIV‐1–infected patients with a CD4 cell count <300 cells/μL than in the other patients with malaria (RR, 1.67 [95% CI, 1.13–2.47]; 
).
Conclusion.HIV‐1–infected patients with malaria with a CD4 cell count <300 cells/μL have a higher risk of experiencing a recrudescent infection, compared with those with a CD4 cell count 300 cells/μL or without HIV‐1 infection.
Trial registered at http://www.clinicaltrials.gov/; reference number NCT00304980.
Received 8 March 2006; accepted 16 May 2006; electronically published 29 August 2006.
Cited by
Alessandro. (2009) HIV-1-Infected Individuals Traveling to Malaria Endemic Areas. JAIDS Journal of Acquired Immune Deficiency Syndromes 51:2, 234-235Online publication date: 1-Jul-2009.
CrossRef
Online publication date: 1-Oct-2008.
CrossRef
Online publication date: 1-Jul-2008.
CrossRef
Online publication date: 1-Apr-2008.
Online publication date: 1-Jan-2008.
CrossRef
Online publication date: 1-Jan-2008.
CrossRef
Online publication date: 1-Dec-2006.
CrossRef
-
Presented in part: 53rd annual meeting of the American Society of Tropical Medicine and Hygiene, Miami Beach, Florida, 7–11 November 2004 (abstract 315).
Potential conflicts of interest: none reported.
Financial support: Belgian Development Co‐operation in the framework of an institutional collaboration between the Tropical Disease Research Center, Ndola, Zambia, and the Institute of Tropical Medicine, Antwerp, Belgium.