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Increased severe anemia in HIV-1-exposed and HIV-1-positive infants and children during acute malaria

Otieno, Richard Oa,b; Ouma, Collinsb,c; Ong'echa, John Mb; Keller, Christopher Cd; Were, Tomb,e; Waindi, Eliud Na; Michaels, Marian Gf; Day, Richard Dg; Vulule, John Mh; Perkins, Douglas Jb,d

doi: 10.1097/01.aids.0000200533.56490.b7
Epidemiology and Social: CONCISE COMMUNICATION

Objective: Since the primary hematological complication in both pediatric HIV-1 and malaria is anemia, co-infection with these pathogens may promote life-threatening severe malarial anemia (SMA). The primary objective of the study was to determine if HIV-1 exposure [HIV-1(exp)] and/or HIV-1 infection [HIV-1(+)] increased the prevalence of SMA in children with acute malaria.

Design: The effect of HIV-1 exposure and HIV-1 infection on the prevalence of SMA (hemoglobin < 6.0 g/dl), parasitemia (parasites/μl), and high-density parasitemia (HDP, ≥ 10 000 parasites/μl) was investigated in children ≤ 2 years of age presenting at hospital with acute Plasmodium falciparum malaria in a rural holoendemic malaria transmission area of western Kenya.

Methods: Upon enrollment, a complete hematological and clinical evaluation was performed on all children. Malaria parasitemia was determined and children with acute P. falciparum malaria were evaluated for HIV-1 exposure and infection by two rapid serological antibody tests and HIV-1 DNA PCR, respectively.

Results: Relative to HIV-1(−) group (n = 194), the HIV-1(exp) (n = 100) and HIV-1(+) (n = 23) groups had lower hemoglobin concentrations (P < 0.001 and P < 0.001, respectively), while parasitemia and HDP were equivalent between the three groups. Multivariate analyses demonstrated that the risk of SMA was elevated in HIV-1(exp) children (odds ratio, 2.17; 95% confidence interval, 1.25–3.78; P < 0.01) and HIV-1(+) children (odds ratio, 8.71; 95% confidence interval, 3.37–22.51; P < 0.0001). The multivariate model further revealed that HIV-1 exposure or infection were not significantly associated with HDP.

Conclusions: Results presented here demonstrate that both HIV-1 exposure and HIV-1 infection are associated with increased prevalence of SMA during acute P. falciparum infection, independent of parasite density.

From the aDepartment of Zoology, Maseno University, Kisumu, Kenya

bUniversity of Pittsburgh/KEMRI Laboratories of Parasitic and Viral Diseases, Centre for Vector Biology and Control Research, Kisumu, Kenya

cDepartment of Pre-Clinical Sciences, School of Health Sciences, Kenyatta University, Nairobi, Kenya

dDepartment of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

eDepartment of Pathology, School of Health Sciences, Kenyatta University, Nairobi, Kenya

fDepartment of Pediatrics, University of Pittsburgh Children Hospital, Pittsburgh, Pennsylvania, USA

gDepartment of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

hKenya Medical Research Institute, Centre for Vector Biology and Control Research, Kisumu, Kenya.

Received 30 August, 2005

Revised 28 September, 2005

Accepted 6 October, 2005

Correspondence to D.J. Perkins, Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 603 Parran Hall, 130 Desoto St., Pittsburgh, PA 15261, USA. Tel: +1 412 624 5894; fax: +1 412 624 4953; e-mail: djp@pitt.edu

© 2006 Lippincott Williams & Wilkins, Inc.