Functional response and mutual interference in the parasitoid Coptera haywardi (Oglobin) (Hymenoptera: Diapriidae) attacking Anastrepha ludens (Loew) (Diptera: Tephritidae) pupae.

Functional response and mutual interference are important attributes of natural enemies that should be analysed in species with the potential to be used as biological control agents in order to increase the predictive power of the possible benefits and/or consequences of their release in the field. Our main objective was to determine the functional response and mutual interference of Coptera haywardi (Oglobin), a pupal parasitoid of economically important fruit flies (Diptera: Tephritidae). The functional response of C. haywardi on A. ludens pupae corresponded to a type II model, with an attack rate of 0.0134 host pupa/h and a handling time of 1.843 h, which reveals a meticulous selection process of pupal hosts. The effect of mutual interference among foraging females was negatively correlated with increased parasitoid density in the experimental arena, showing a gradual decline in attack rate per individual female. The increase in the number of foraging females also had an impact on the number of oviposition scars per pupa and the number of immature parasitoids per dissected pupa, but not on the percentage of adult emergence or the sex ratio. Our results suggest that C. haywardi could act as a complementary parasitoid in the control of fruit fly pupae, since the random distribution of these pupae in the soil would decrease the possibility of aggregation and mutual interference between foraging females.

Interference of tritrophic (grape × medfly × parasitoid) interactions by mineral and biomaterial films.

Fruit fly infestation is one of the main obstacles to the exportation of fresh agricultural produce. Films of mineral particles and biomaterials have the potential to protect fruits against tephritid fruit fly infestation. The present study evaluated the effects of particle films on the tritrophic interactions of grape (Vitis vinifera L.), the fruit fly Ceratitis capitata (Wiedemann) and the parasitoid Diachasmimorpha longicaudata (Ashmead) under semi-field conditions. Grapes were biometrically characterised (i.e. colour, firmness, mass, length and diameter), treated with mineral particles, biomaterials or distilled water (control), and then used in oviposition and parasitism bioassays. In the oviposition bioassay, the treated grapes were exposed to 50 C. capitata pairs in field cages, and after 48 h, the punctures and eggs on each fruit were counted. In the parasitism bioassay, treated grapes were artificially infested with third-instar C. capitata larvae (two per fruit), exposed (2 h) to 50 D. longicaudata pairs in field cages to determine parasitism index, larval and pupal viabilities and number of flies and parasitoids emerged. Treatment with the mineral film affected fruit colour and reduced C. capitata oviposition but failed to significantly affect the parasitism capacity of D. longicaudata. The ability of the parasitoid to locate and parasitise C. capitata larvae in kaolin-coated fruits suggests that kaolin films could be used in conjunction with biological agents to control fruit flies.

Bacterial Diversity Associated with Anastrepha obliqua Males Change Under Mass-Rearing Conditions and with Irradiation.

Recent advances in understanding the symbiotic interactions between bacteria and fruit flies have shown that they are relevant for mass rearing and the sterile insect technique (SIT). SIT involves mass production and release of sterile insects that would copulate with their wild conspecifics and thus decrease the population growth rate. The irradiation process used to sterilize mass-reared flies can modify the diversity and structure of the midgut bacterial communities, which could affect sterile male survival, flight capacity, and sexual competitiveness. Our aim was to compare bacterial communities in the midgut of wild and mass-reared Anastrepha obliqua (Macquart) males irradiated at 0, 60, and 80 Gy. After adult's emergence, their midguts were dissected, DNA was extracted, and high-throughput sequencing of the V3-V4 region of the 16S rDNA gene was performed. A total of 11 phyla, 17 classes, 47 families, and 52 genera of bacteria were identified. The most representative phylum was Proteobacteria and the predominant family was Enterobacteriaceae. We found that wild males had a different intestinal bacterial community from mass-reared males. In addition, irradiation at 60 and 80 Gy caused changes in the diversity and structure of the midgut microbiota of these sterile males, suggesting that mass rearing and irradiation cause artificial selection of the bacterial communities in the gut of A. obliqua males.

Superparasitism and fitness parameters in three native wasp parasitoids (Braconidae: Opiinae) of the Mexican fruit fly, Anastrepha ludens (Diptera: Tephritidae).

Knowledge on reproductive strategies and host use in insect parasitoids is fundamental for biological control purposes. Superparasitism and multiparasitism, oviposition in a previously parasitized host by a female of the same or different species, respectively, may impact pest management decisions. Our objective was to determine the occurrence of superparasitism and multiparasitism in three species of native larval-pupal solitary endoparasitoids that attack Anastrepha Shiner species (Diptera: Tephritidae) in the Neotropical region, and the possible effect on offspring fitness parameters. Doryctobracon crawfordi (Viereck), Utetes anastrephae (Viereck), and Opius hirtus (Fischer) occur in sympatry in Mexico, and are currently under consideration for use as biocontrol agents. Experiments were conducted under laboratory conditions with females acting alone (self-superparasitism), females in groups of the same species (conspecific superparasitism), and females in mixed groups (multiparasitism). Our results showed that self-superparasitism is an uncommon strategy in the three native species and is rare under conditions of intraspecific competition. In the case of multiparasitism, a higher number of immature stages of U. anastrephae was observed, compared to those of D. crawfordi and O. hirtus. However, it is not clear yet if this was due to some adult female trait or to the competitive ability of the larvae. We conclude that most females of the native species studied appeared to avoid superparasitism, specifically when acting alone, suggesting a high discrimination ability, which is probably a result of a close relationship and evolutionary history with Anastrepha hosts.

Clinical outcome of patients with COVID-19 Pneumonia treated with corticosteroids and colchicine in Colombia.

BACKGROUND: To date, there is no specific antiviral therapy for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) that causes Coronavirus disease 2019 (Covid-19). Since there is no specific therapy against SARS-CoV2, current efforts aim to prevent contagion through public health measures and develop a protective vaccine. While waiting for the latter, it is necessary to evaluate the drugs that at least, in initial studies, suggested some degree of utility in the management of Covid-19 or its complications. The main objective of the study was to describe the clinical manifestations and outcomes of patients with severe Covid-19 Pneumonia treated with corticosteroids and colchicine. MATERIALS AND METHODS: A cross sectional study of 301 adult patients with Covid-19 Pneumonia confirmed by Real-Time Polymerase Chain Reaction for SARS-CoV2 (RT-PCR SARS-CoV2), Berlin protocol, who required hospitalization in three hospitals in Antioquia, Colombia. Patients were treated according to the institutional protocol (from March 20, 2020 to June 30, 2020) with corticosteroid if the patient required supplemental oxygen. From July 1, 2020, the management protocol changed with the addition of colchicine to all patients admitted to the institutions. The treatment was supervised and monitored by the same specialist in Infectology of the institutions. We describe the clinical manifestations and outcomes of the patients who received these treatments. The information of the patients was analyzed according to the outcome of interest (alive/dead) with univariate, bivariate, and multivariate measures to adjust the variables that presented statistical association. RESULTS: All patients had pneumonia documented by chest computed tomography with ground glass images and presented an alveolar pressure/inspired oxygen fraction (PaFi) less than 300. Three hundred one patients were included, 240 (79.7%) received corticosteroids, within these 145 (48.2%) received colchicine also, and the remaining 61 (20.3%) patients did not receive corticosterioids or colchicine. Mortality in the group that received colchicine was lower compared to the group that did not receive it (9.6 vs 14.6%, p-value = 0.179). CONCLUSIONS: Treatment with corticosteroids and colchicine for managing patients with severe Covid-19 Pneumonia was associated with low mortality at the hospital level. Randomized, placebo-controlled studies are required to evaluate the effect of corticosteroids and colchicine on complications or death from Covid-19.

Irradiation of early immature Anastrepha ludens stages for the rearing of Doryctobracon areolatus (Hymenoptera: Braconidae), a fruit fly parasitoid.

Doryctobracon areolatus is a native parasitoid of the Neotropical region that presents the highest percentages of natural parasitism of fruit flies of the genus Anastrepha. In the Moscafrut Program SADER-SENASICA, located in Metapa de Domínguez, Chiapas, Mexico, a laboratory colony of this species is maintained on Anastrepha ludens, the Mexican fruit fly, with the aim to scale the production of the parasitoid up to massive levels. In order to eliminate unwanted emergence of adult flies during the rearing process, this study evaluated the effect of irradiation (at doses of 20, 30, 40, and 50 Gy) applied to eggs, and first and second instar larvae of A. ludens; all irradiated stages were subsequently exposed as second instar larvae to adult females of D. areolatus. Irradiation did not affect the eclosion of A. ludens eggs but, at doses of 40 and 50 Gy, it did cause delayed larval development and pupation, as well as lower larval weight. Adult fly emergence was suppressed at all doses, except in eggs irradiated at 20 Gy. Doses of 20 and 30 Gy applied to the eggs and larvae did not affect the emergence, survival, fecundity or flight ability of the emerged parasitoids, but the second instar larvae were easily handled during the rearing process. Our results suggest that D. areolatus can be successfully produced in second instar larvae of A. ludens irradiated at 30 Gy.

Interaction Between Beauveria bassiana (Hypocreales: Cordycipitaceae) and Coptera haywardi (Hymenoptera: Diapriidae) for the Management of Anastrepha obliqua (Diptera: Tephritidae).

The interaction between the entomopathogenic fungus Beauveria bassiana (Balsamo) and the parasitoid Coptera haywardi (Oglobin), as potential biological control agents for Anastrepha obliqua (Macquart) fruit flies, was evaluated under laboratory and semi-protected field cage conditions. The effects of the parasitoids and fungus were individually and jointly assessed in Plexiglas cages. Application of B. bassiana dry conidia to soil produced 40% mortality in A. obliqua adults. However, mortality was lower (21.2%) on evaluation under field cage conditions. According to the multiple decrement life table analysis, the probability of death of A. obliqua was 88% when C. haywardi parasitoids and B. bassiana conidia were used in conjunction, 89% when only C. haywardi parasitoids were released and 23% when only B. bassiana conidia were applied. These results demonstrate that no synergistic, additive or antagonistic interaction took place with the simultaneous use of these natural enemies, since the presence of B. bassiana had no effect on the C. haywardi parasitism. These results indicate that the parasitoid is a better natural enemy for the control of A. obliqua, and show that, although the two biological control agents can be used simultaneously, their joint application will not produce increased control.

Synthesis of exo-Imidazolidin-2-one Dienes, Their Isomerization, and Selectivity in Diels-Alder Cycloadditions.

An efficient and alternative synthesis of exo-imidazolidin-2-one dienes is described. A condensation reaction was carried out with bis-imino derivatives, diacetyl, and triphosgene, affording symmetrically N, N-disubstituted dienes. The use of alkyl methyl α-diketones led to the formation of nonsymmetrical dienes, which underwent isomerization to provide more stable inner-outer-ring dienes under Lewis acid conditions. Evaluation was made of the reactivity as well as regio- and stereoselectivity of these dienes in Diels-Alder reactions. They proved to be highly reactive and selective. DFT calculations of the transition states accounted for their behavior.

Comparison of Anastrepha ludens (Diptera: Tephritidae) Bisexual and Genetic Sexing (Tapachula-7) Strains: Effect of Hypoxia, Fly Density, Chilling Period, and Food Type on Fly Quality.

The use of genetic sexing strain (GSS) insects in the sterile insect technique (SIT) makes necessary the revision of quality parameters of some stressful steps used during the packing process for aerial release because of possible differences in tolerance between fly strains. Here, we determined the effect of three periods of hypoxia (12, 24, and 36 h at pupal stage), three cage densities (1.0, 1.3, and 1.5 flies/cm2), two different foods (protein/sugar (1/24) and Mubarqui), and three chilling times (20 min [control], 90, and 180 min) on the quality parameters of flies of two Anastrepha ludens (Loew) strains (bisexual and GSS Tapachula-7). In general, the response to stressful conditions of both fly strains was qualitatively equivalent but quantitatively different, as flies of both strains responded equally to the stressful factors; however, flies of Tapachula-7 exhibited lower quality parameters than the control flies. Thus, hypoxia affected the flying ability but not the emergence or longevity of flies. The food type affected the adult weight; protein/sugar produced heavier flies that also survived longer and had a greater mating propensity. Flies under the lowest density were better fliers that those at the other two densities. Increasing chilling time reduced flight ability but not longevity or mating propensity. The implications of these findings for the use of A. ludens GSS in SIT programs are discussed herein.

Transmission of nevirapine-resistant HIV type 1 via breast milk to infants after single-dose nevirapine in Beira, Mozambique.

Acquisition of nevirapine (NVP)-resistant human immunodeficiency virus type 1 (HIV-1) by breast-feeding infants after receipt of single-dose NVP to prevent mother-to-child transmission is not well defined. A prospective observational study of 307 infants evaluated the rate of breast milk transmission of NVP-resistant HIV and the concentrations of mutants over time. NVP resistance was detected in 9 of 24 infants (37.5%; 95% confidence interval, 18.8%-59.4%) infected via breast milk. Eight had a pure mutant HIV population at the time infection was first detected, and majority mutant populations persisted in all 6 infants with follow-up specimens. Infection of breast-feeding infants with NVP-resistant HIV resulted in mutants persisting as the dominant virus, which may indefinitely compromise treatment with NVP-based antiretroviral regimens.

Effect of multiple endogenous biological factors on the response of the tephritids Anastrepha ludens and Anastrepha obliqua (Diptera: Tephritidae) to multilure traps baited with BioLure or NuLure in mango orchards.

The physiological state of an insect is likely the most important endogenous factor influencing resource-oriented behavior, and it varies considerably among individuals. Trials were conducted in mango orchards to study the effect of multiple endogenous biological factors on the response of two fly species, Anastrepha ludens (Loew) and Anastrepha obliqua Maquart (Diptera: Tephritidae), to BioLure and NuLure baits. The biological factors of the two fly species that were tested were the following: 1) fertility status-sterile (irradiated) and fertile flies; 2) two types of diets (only sugar and a 3:1 mixture of sugar and hydrolyzed yeast protein; 3) sex, and 4) two sexual maturity conditions (2-4- and 15-18-d-old flies, representing immature and sexually mature flies, respectively, and 2-4-d-old flies treated with methoprene as an artificially induced sexually state male condition). The laboratory-treated flies were released into three different mango orchards. The trials were conducted in four blocks per orchard using eight traps in each block (50:50 BioLure: NuLure). The traps were replaced every 2 d during the 12-d period and the flies per trap per day values were calculated. More protein-fed, fertile, female, immature, and A. obliqua flies were caught compared with the other flies tested. In addition, the traps baited with NuLure attracted more flies than those baited with BioLure. Interaction analyses indicated that the type of bait and the sexual maturity status were the most important factors affecting the responses of the flies. Our study demonstrated that lures attract only a small segment of the fly population, those that have a specific hunger for amino acids-immature flies-and those that were protein-starved. The implications for improved trapping system designs are discussed.

Behavioral response of two species of stingless bees and the honey bee (Hymenoptera: Apidae) to GF-120.

We present the results of evaluating the response of three species of bees, Trigona fulviventris (Guérin), Scaptotrigona mexicana (Guérin-Meneville), and Apis mellifera (L.), to food sources baited with the toxic bait GF-120 (NF Naturalyte), a spinosad-based bait exclusively used to manage fruit flies. Groups of foragers were trained to collect honey and water from a feeder located 50 m from the colonies. Once a sufficient number of foragers were observed at the experimental location, the training feeder was changed to two or three feeders that offered either honey and water, GF-120, Captor (hydrolyzed protein), GF-120 and honey (4:6), or Captor and honey (1:19). T fulviventris and S. mexicana rarely visited GF-120, Captor, or their mixtures with honey, while approximately 28.5 and 1.5% of A. mellifera foragers visited the GF-120 and honey and Captor and honey mixtures, respectively. Our results show that GF-120 clearly repels T. fulviventris and S. mexicana, whereas for A. mellifera, repellence is not as marked when GF-120 is combined with highly nutritious substances like honey.

Estimation of populations and sterility induction in Anastrepha luden (Diptera: Tephritidae) fruit flies.

The relationship between different release densities of sterile flies and fly trap captures, expressed as flies per trap per day, in the monitoring of Anastrepha ludens (Loew) populations was evaluated in mango orchards. The induction of sterility in fertile females was evaluated using different ratios of sterile: fertile males under field cage conditions. A direct relationship between recaptured flies and densities of release sterile flies was found. However, trap efficiency, expressed as percentage of recaptured flies, decreased as the density of released flies increased. Sterility induction was positively correlated to the ratio of sterile: fertile flies. A significant difference in egg fertility among treatments was observed. The trajectory of sterility induction slowed down after a sterile: wild ratio of 30:1, which suggests that this ratio could be appropriate in an sterile insect technique program with A. ludens. Sterility induction was greater when only sterile males were released than when releasing both sterile males and females, but the differences were not significant. Our findings contribute to a better interpretation of fly captures obtained from the field trapping networks, and to an improvement in the efficiency of sterile insect technique against A. ludens fruit flies, through the implementation of more rational sterile fly release densities.

Excess Child Mortality Associated With Colombia's Armed Conflict, 1998-2019.

Importance: Armed conflicts are directly and indirectly associated with morbidity and mortality due to destruction of health infrastructure and diversion of resources, forced displacement, environmental damage, and erosion of social and economic security. Colombia's conflict began in the 1940s and has been uniquely long-lasting and geographically dynamic. Objective: To estimate the proportion of infant and child mortality associated with armed conflict exposure from 1998 to 2019 in Colombia. Design, Setting, and Participants: This ecological cohort study includes data from all 1122 municipalities in Colombia from 1998 to 2019. Statistical analysis was conducted from February 2022 to June 2023. Exposure: Armed conflict exposure was measured dichotomously by the occurrence of conflict-related events in each municipality-year, enumerated and reported by the Colombian National Center for Historic Memory. Main Outcomes and Measures: Deaths among children younger than 5 years and deaths among infants younger than 1 year, offset by the number of births in that municipality-year, enumerated by Colombia's national vital statistics. Results: The analytical sample included 24 157 municipality-years and 223 101 conflict events covering the period from 1998 to 2019. Overall, the presence of armed conflict in a municipality was associated with a 52% increased risk of death for children younger than 5 years of age (relative risk, 1.52 [95% CI, 1.34-1.72]), with similar results for 1- and 5-year lagged analyses. Armed conflict was associated with a 61% increased risk in infant (aged <1 year) death (relative risk, 1.61 [95% CI, 1.43-1.82]). On the absolute scale, this translates to a risk difference of 3.7 excess child deaths per 1000 births (95% CI, 2.7-4.7 per 1000 births) and 3.0 excess infant deaths per 1000 births (95% CI, 2.3-3.6 per 1000 births) per year, beyond what would be expected in the absence of armed conflict. Across the 22-year study period, the population attributable risk was 31.7% (95% CI, 23.5%-39.1%) for child deaths and 35.3% (95% CI, 27.8%-42.0%) for infant deaths. Conclusions and Relevance: This ecological cohort study of Colombia's spatiotemporally dynamic armed conflict suggests that municipal exposure to armed conflict was associated with excess child and infant deaths. With a record number of children living near active conflict zones in 2020, policy makers and health professionals should understand the magnitude of and manner in which armed conflicts directly and indirectly undermine child health.

Palladium-catalyzed synthesis of natural and unnatural 2-, 5-, and 7-oxygenated carbazole alkaloids from N-arylcyclohexane enaminones.

A palladium-catalyzed synthesis of the carbazole framework is described, including the preparation of 2-, 5-, and 7-oxygenated natural and unnatural carbazole alkaloids. A series of N-arylcyclohexane enaminones, generated by condensation of cyclohexane-1,3-dione with diverse anilines, were aromatized by a Pd(0)-catalyzed thermal treatment to afford the corresponding diarylamines. The latter were submitted to a Pd(II)-catalyzed cyclization and methylation processes to provide the desired carbazoles, including clausine V. Following an inverse strategy, a new and short total synthesis of glycoborine is also reported.

Effects of short-course zidovudine on the selection of nevirapine-resistant HIV-1 in women taking single-dose nevirapine.

Single-dose nevirapine (sdNVP) given to prevent mother-to-child-transmission of HIV-1 selects NVP-resistance. Short-course zidovudine (ZDV) was hypothesized to lower rates of NVP-resistance. HIV-1 infected pregnant women administered sdNVP with or without short-course ZDV were assessed for HIV-1 mutations (K103N, Y181C, G190A, and V106M) prior to delivery and postpartum. Postpartum NVP-resistance was lower among 31 taking ZDV+sdNVP compared to 33 taking only sdNVP (35.5% vs. 72.7%; χ2 P = .003). NVP mutants decayed to <2% in 24/35 (68.6%) at a median 6 months postpartum, with no differences based on ZDV use (logrank P = .99). Short-course ZDV was associated with reduced NVP-resistance mutations among women taking sdNVP.

Additive Effect of Releasing Sterile Insects Plus Biocontrol Agents against Fruit Fly Pests (Diptera: Tephritidae) under Confined Conditions.

Pest control models integrating the use of the sterile insect technique (SIT) and augmentative biological control (ABC) have postulated that it is possible to obtain a synergistic effect from the joint use of these technologies. This synergistic effect is attributed to the simultaneous attack on two different biological stages of the pest (immature and adult flies), which would produce higher suppression on the pest populations. Here we evaluated the effect of the joint application of sterile males of A. ludens of the genetic sexing strain Tap-7 along with two parasitoid species at the field cage level. The parasitoids D. longicaudata and C. haywardi were used separately to determine their effect on the suppression of the fly populations. Our results showed that egg hatching percentage was different between treatments, with the highest percentage in the control treatment and a gradual reduction in the treatments with only parasitoids or only sterile males. The greatest induction of sterility (i.e., the lowest egg hatching percentage) occurred with the joint use of ABC and SIT, demonstrating that the earlier parasitism caused by each parasitoid species was important reaching high levels of sterility. Gross fertility rate decreased up to 15 and 6 times when sterile flies were combined with D. longicaudata and C. haywardi, respectively. The higher parasitism by D. longicaudata was determinant in the decrease of this parameter and had a stronger effect when combined with the SIT. We conclude that the joint use of ABC and SIT on the A. ludens population had a direct additive effect, but a synergistic effect was observed in the parameters of population dynamics throughout the periodic releases of both types of insects. This effect can be of crucial importance in the suppression or eradication of fruit fly populations, with the added advantage of the low ecological impact that characterizes both techniques.

Effect of the Sterile Insect Technique and Augmentative Parasitoid Releases in a Fruit Fly Suppression Program in Mango-Producing Areas of Southeast Mexico.

The Sterile Insect Technique (SIT), by means of sterile male releases of Anastrepha ludens (Loew), coupled with Augmentative Biological Control (ABC), by releasing the parasitoid Diachasmimorpha longicaudata (Ashmead), was evaluated in a commercial mango production area for one year. The obtained results were compared with mean fruit fly population values from two previous years without the combined use of both techniques. The treatments were: SIT + ABC, SIT, ABC, and Control, and each treatment was established in blocks of 5000 Ha separated by distances of 5-10 km. The evaluations were carried out through fruit sampling to assess percent parasitism and trapping of adult flies to obtain Flies per Trap per Day (FTD) values. The mean percentage of parasitism increased from 0.59% in the control treatment to 19.38% in the block with ABC. The FTD values decreased from ~0.129 and ~0.012 in the control block to 0.0021 in the block with SIT and ABC, representing a 98% suppression. The difference between the two periods in the control block was not significant. We conclude that the integration of both techniques resulted in an additive suppression of the pest population, supporting the use of both control techniques in an area-wide pest management context.

Immature stages of Utetes anastrephae (Hymenoptera: Braconidae) developed in Anastrepha fruit fly larvae (Diptera: Tephritidae).

The morphology of the immature stages of Utetes anastrephae (Hymenoptera: Braconidae), a native parasitoid of larvae of flies of the Neotropical genus Anastrepha (Diptera: Tephritidae), is shown. This study aimed to characterize the immature stages and morphological changes in the development of the koinobiont endoparasitoid in two species of larval hosts, Anastrepha obliqua and Anastrepha ludens. The definition of structures and morphological changes during development was made through daily microscopic observations and photographs of dissected hosts. The immature development of the parasitoid corresponds to a holometabolous insect with three well-defined stages: egg (two days), larva with three larval instars (approximately eight days), and pupa (six days). Similar development times were obtained in the two host species. Males and females completed their cycle in 17 and 18 days, respectively. During egg-first instar development, host antagonistic activity through melanization and encapsulation as mortality factors was evident and frequent only in A. obliqua. These results serve as basic knowledge for the use of this parasitoid in the biological control of fruit flies.

Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique.

BACKGROUND: Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria. METHODS: HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status. RESULTS: HIV-1 seroprevalence was 11% (74/655) in children under 15 years and 72% (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26% (19/74) versus 9% (53/581) in uninfected children (P < .001). In an age- and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration. CONCLUSIONS: Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria.