Is HIV infection associated with the clinical course of severe malaria

Abstract

The malaria season 1995-1996 was the worst ever recorded in history in Zimbabwe regarding morbidity and mortality, especially in Matabeleland North.Particularly worrying was the observation that relatively mild cases of malaria rapidly progressed to severe and complicated malaria, and many of these patients died. The AIDS pandemic also affects Zimbabwe badly. Sentinel studies on ANC attenders in Binga and Hwange showed an increase in HIV seropositivity from 13.2% in 1993 to 21.5% in 1996. A research question: "Is HIV infection associated with the clinical course of severe malaria?" was formulated. The general objective of the study was to answer the research question. Specific objectives were: - to compare case fatality rates in HIV (+) and HIV (-) patients admitted for severe malaria- to compare length of stay in hospital in HIV (+) and HIV (-) severe malaria patients;- to compare the treatment given to HIV (+) and HIV (-) patients, and - if the findings so suggest, to come up with a recommendation regarding prevention of malaria in HIV (+) people.

A cohort study was conducted in four hospitals in Matabeleland North Province, Zimbabwe, from 1/3/97-30/6/97. The subjects in the study were 100 patients, admitted for severe malaria, with a positive malaria slide, treated with parenteral quinine, and 15 years old or above.

Results:

From the 100 patients (59 male, 41 female) 59 were HIV (+) and 41 HIV (-). This HIV seropositivity rate in the study population (59%) was almost three times as high as that from the population it was drawn from (20%).

19/59 (32.3%) in the HIV (+) group died versus 6/41 (14.6%) in the HIV (-) group (RR 2.2; 95% CI 0.96-5.03; P-value = 0.078). Although not statistically significant- probably because of the small sample size- this case fatality rate for HIV (+) patients was more than twice the one for HIV (-) patients.

The median stay in hospital was 5 days (3-7) for HIV ( + ) and 4 days (3-6) for HIV (-) patients. (P = 0.232)

The findings suggest a possible association between HIV infection and the clinical course of severe malaria. As the answer to the research question has major public health implications, especially in areas with a high HIV prevalence, a large multicentre study along the lines of the present one is indicated.