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HIV INFECTION AND THE INCIDENCE OF MALARIA AMONG HIV-EXPOSED CHILDREN FROM TANZANIA

Friday, 27th of April 2012

‘HIV infection is a risk factor for the development of malaria.’

1. First published online: March 28, 2012

• HIV INFECTION AND THE INCIDENCE OF MALARIA AMONG HIV-EXPOSED CHILDREN FROM TANZANIA

 

J Infect Dis. (2012) 205 (10): 1486-1494.

Abstract below ; full text to subscribers of J Infect Dis

  

   Amara E. Ezeamama1, Donna Spiegelman2,3, Ellen Hertzmark3, Ronald J. Bosch3,4,

   Karim P. Manji5, Christopher Duggan1,6,  Roland Kupka1,7,  Melanie W. Lo8,  James O. Okuma1,

   Rodrick Kisenge5, Said Aboud5,9 and Wafaie W. Fawzi1

+ Author Affiliations

1. 1.       ¹Department of Nutrition
2. 2.       ²Department of Epidemiology
3. 3.       ³Department of Biostatistics
4. 4.       ⁴Center for Biostatistics in AIDS Research, Harvard School of Public Health
5. 5.       ⁵Department of Pediatrics and Child Health, School of Medicine
6. 6.       ⁶Division of Gastroenterology and Nutrition, Children's Hospital, Boston, Massachusetts
7. 7.       ⁷United Nations Children's Fund, Regional Office for West and Central Africa, Dakar, Senegal
8. 8.       ⁸University of Minnesota Medical School, Minneapolis
9. 9.       ⁹Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
10. Correspondence: Amara E. Ezeamama, PhD, Department of Nutrition, Harvard School of Public Health, 667 Huntington Ave, Bldg 2, Room 302, Boston, MA 02115 (aezeamam@hsph.harvard.edu).

Abstract

Objective To determine whether human immunodeficiency virus (HIV) infection is associated with increased risk of malaria incidence and recurrence in children.

Methods Newborn infants of HIV-infected mothers were enrolled at 6 weeks and followed for 2 years. HIV status was assessed by enzyme-linked immunosorbant assay and confirmed by HIV DNA polymerase chain reaction. Malaria was defined as (1) physician-diagnosed clinical malaria; (2) probable malaria, in which laboratory testing is requested for parasitemia; and (3) blood smear–confirmed malaria. Cox proportional hazards models estimated hazard ratios (HRs) for development of first and second malaria episodes, and generalized estimating equation models estimated malaria rate differences per 100-child-years in relation to time-updated HIV status.

Results Child HIV infection was associated with clinical (HR, 1.34; 95% confidence interval [CI], 1.12–1.61), probable (HR, 1.47; 95% CI, 1.19–1.81), and confirmed (HR, 1.67; 95% CI, 1.18–2.36) malaria episodes. Per 100 child-years, HIV-infected children experienced 88 (95% CI, 65–113), 36 (95% CI, 19–53), and 20 (95% CI, 9–31) more episodes of clinical, probable, and confirmed malaria episodes, respectively, than HIV-uninfected children. Among children with ≥1 malaria episodes, those with HIV infection developed second clinical (HR, 1.28; 95% CI, 1.04–1.57), probable (HR, 1.60; 95% CI, 1.26–2.14), and confirmed (HR, 2.27; 95% CI, 1.06–3.89) malaria sooner than HIV-uninfected children.

Conclusions HIV infection is a risk factor for the development of malaria. Proactive malaria disease prevention and treatment is warranted for all children, particularly those with HIV infection in settings of coendemicity.