1018 Malaria and co-infection with HIV

In referring to morbidity and mortality risks in Africa, many texts cite HIV/AIDS, tuberculosis and malaria. In South Africa the first two are certainly important and receive attention, but perhaps because malaria is less prevalent it is relatively neglected. April 25th, World Malaria Day, passed without much publicity, possibly missing an opportunity to link the parasitic disease to the national HIV-testing campaign that was about to be rolled out. In perinatal and paediatric terms the link is important, and is associated with significant morbidity and mortality in pregnant women and their offspring. HIV-parasitaemia, parasitaemia-viral load and malaria-low CD4 associations that have been demonstrated are probably at the heart of these presentations. HIV-associated immunosuppression not only contributes to more frequent and more sever malaria, but also to reduced efficacy of antimalarials in pregnant women. Co-infection with these two diseases during pregnancy is associated with anaemia, low birthweight and increased risk of infant mortality to a greater extent than either disease alone. In 2006 it was estimated that each year one million sub-Saharan pregnancies are complicated by co-infection. This might have changed with global initiatives that have funded interventions such as insecticide-treated nets, but on the other hand artemisinin resistance in patients and insecticide resistance in vectors are frustrating such efforts. Returning to the matter of co-infection, simultaneous treatment of both diseases is complicated. For example, sulfadoxine-pyrimethamine should be prescribed with caution in women receiving nevirapine and/or zidovudine and should be avoided if co-trimoxazole is being prescribed. Some antimalarials alter glutathione levels and may exacerbate the oxidation-reduction imbalance found in HIV infection. In addition there are concerns that combination treatment of co-infection might have adverse developmental effects on the foetus.

Read more:
Lancet 2010; 375: 1407
Trans R Soc Trop Med Hyg 2009; 103: 761-7
Ann Trop Paediatr 2009; 29: 71-83