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Impact of HIV-1 Infection on the Hematological Recovery After Clinical Malaria

Van geertruyden, Jean-Pierre MD, PhD*; Mulenga, Modest MD, PhD; Chalwe, Victor MD, MSc; Michael, Nambozi MD; Moerman, Filip MD, MSc*; Mukwamataba, Doreen; Colebunders, Robert MD, PhD*‡; D'Alessandro, Umberto MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: February 2009 - Volume 50 - Issue 2 - p 200-205
doi: 10.1097/QAI.0b013e3181900159
Epidemiology and Social Science

Background: Anemia is the most frequent cytopenia in HIV-infected individuals and is often associated with malaria.

Objective: To assess the impact of HIV-1 on the hematological recovery after a clinical malaria episode.

Methods: In Ndola, Zambia, a region with high malaria and HIV prevalence, hemoglobin (Hb) was measured in 634 malaria patients 14 and 45 days after antimalarial treatment. Risk factors for hematological recovery were analyzed in a multivariate linear regression model.

Results: At enrollment, HIV-1-infected malaria patients had lower Hb compared with HIV-1 uninfected (122.7 vs 136.0 g/L; P < 0.001). In both groups, mean Hb was significantly lower at day 14 posttreatment than day 0 (P < 0.0001) and significantly higher at day 45 than at day 14 (HIV-1 negative: P = 0.0001; HIV-1 infected: P = 0.005). HIV-1 was a risk factor for a larger Hb decrease until day 14 (P < 0.001) and slower recovery until day 45 (P = 0.048). When considering the whole 45-day follow-up period, mean Hb increased in the HIV-1-negative group (+3.54 g/L; 95% confidence interval: 1.37 to 5.70; P = 0.001) but not in the HIV-1-infected group (−0.72 g/L; 95% confidence interval: −3.85 to +2.40; P = 0.64). HIV-1 infection as such (P < 0.0001), not CD4 cell count (P = 0.46), was an independent risk factor for a slower hematological recovery.

Conclusions: HIV-1-infected malaria patients had a slower hematological recovery after successful parasite clearance. Malaria preventive measures should be targeted to this high-risk group.

From the *Departments of Parasitology, and Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; †Department of Clinical Sciences, Tropical Disease Research Center, Ndola, Zambia; and ‡Faculty of Medicine, University of Antwerp, Antwerp, Belgium.

Received for publication May 16, 2008; accepted September 29, 2008.

Supported by funding from the Belgian Development Cooperation in the framework of an institutional collaboration between the Tropical Disease Research Center in Ndola and the Institute of Tropical Medicine in Antwerp. Budget number: 96603.

Presented in part at the 5th European Congress on Tropical Medicine and International Health, Amsterdam, The Netherlands; and Van geertruyden JP, Mulenga M, Chalwe V, Nambozi M, Mukwamataba D, Colebunders R, D'Alessandro U. Impact of HIV-1 infection on the hematological recovery after a clinical malaria attack [abstract O28-31]. In: Abstracts of the 5th European Congress on Tropical Medicine and International Health, Amsterdam, The Netherlands. Trop Med Int Health. 2007;12(S1):137.

Conflict of interest stated: On behalf of my coauthors, I declare that none of the coauthors have stated any conflict of interest regarding the content of this article.

Trial registry:; reference number NCT00304980.

Correspondence to: Jean-Pierre Van geertruyden, MD, PhD, Department of Parasitology, Unit of Epidemiology, Institute of Tropical Medicine, Nationalestraat 155, B2000 Antwerp, Belgium (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.