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Imported Malaria in HIV-Infected Patients Enrolled in the ANRS CO4 FHDH Study

Mouala, Christian MD, MPH*†; Houzé, Sandrine MD; Guiguet, Marguerite PhD*†; Abboud, Philippe MD§; Pialoux, Gilles MD, PhD; Viget, Nathalie MD; Costagliola, Dominique PhD*†#; Matheron, Sophie MD, PhD**

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1st, 2008 - Volume 49 - Issue 1 - p 55-60
doi: 10.1097/QAI.0b013e31817e635b
Clinical Science

Background: To describe episodes of imported malaria in human immunodeficiency virus type 1-infected patients and to study the risk factors for severe Plasmodium falciparum malaria.

Methods: Patients enrolled in the French Hospital Database on HIV who were diagnosed with a first episode of malaria between 1996 and 2003 were included. The severity of P. falciparum imported malaria was graded with World Health Organization criteria. Geographic areas were classified according to P. falciparum chemoresistance. Risk factors for severe malaria were identified with logistic regression.

Results: We studied 190 patients infected by P. falciparum in 178 cases. All but four of the patients were infected in sub-Saharan Africa, and half were returning from a country with a high P. falciparum chloroquine resistance. Their median age was 37.5 years, and 57% came from a country endemic with malaria. The median CD4 cell count was 299/mm3, and the median plasma human immunodeficiency virus type 1 RNA load was 4.5 log10 copies/mL. Sixty-five (36.5%) episodes of P. falciparum malaria were severe. Severe imported malaria was associated with CD4 cells/mm3 <350 (odds ratio = 2.58; 95% confidence interval: 1.19 to 5.57). The risk of severe malaria was lower in patients returning from a country with a high prevalence of chemoresistance (odds ratio = 0.50; 95% confidence interval: 0.25 to 0.99).

Conclusions: Severe imported malaria in human immunodeficiency virus type 1-infected patients is associated with decreased CD4 cell count. The risk seems lower when P. falciparum infection was acquired in areas of high prevalence of chemoresistance.

From the *INSERM, U720, Paris, F-75013 France; †UPMC Univ Paris 06, UMR S270, F-75013, Paris, France; ‡Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Bichat Claude Bernard, Service de parasitologie, Paris, F-75018 France; §Rouen University Hospital, Service de maladies infectieuses et tropicales, Rouen, France; ‖Assistance Publique-Hôpitaux de Paris, Groupe hospitaalier Tenon, Service de maladies infectieuses et tropicales, Paris, F-75020 France; ¶Centre Hospitalier de Tourcoing, Service universitaire des maladies infectieuses et du voyage, Tourcoing, France; #Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Pitié-Salpêtrière, Service de maladies infectieuses et tropicales, Paris, F-75013 France; and **Assistance Publique-Hôpitaux de Paris, Groupe hospitalier Bichat Claude Bernard, Service de maladies infectieuses et tropicales, Paris, F-75018 France.

Received for publication January 29, 2008; accepted April 25, 2008.

Supported by Agence Nationale de Recherches sur le SIDA et les hépatites (ANRS), Institut national de la santé et de la recherche médicale, and the French Ministry of Health.

Presented in part at the 4th International AIDS Conference, July 22-25, 2007, Sydney, Australia and the 47th Interscience Conference on Antimicrobial Agents and Chemotheraphy Conference, September 17-20, 2007, Chicago, IL.

Correspondence to: Christian Mouala, MD, INSERM, U720, Paris, F-75013 France (e-mail: cmouala@ccde.chups.jussieu.fr).

© 2008 Lippincott Williams & Wilkins, Inc.