Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study.
Lancet
; 356(9235): 1051-6, 2000 Sep 23.
Article
em En
| MEDLINE
| ID: mdl-11009139
ABSTRACT
BACKGROUND:
An association between HIV-1 and malaria is expected in theory, but has not been convincingly shown in practice. We studied the effects of HIV-1 infection and advancing immunosuppression on falciparum parasitaemia and clinical malaria.METHODS:
HIV-1-positive and HIV-1-negative adults selected from a population-based cohort in rural Uganda were invited to attend a clinic every 3 months (routine visits) and whenever they were sick (interim visits). At each visit, information was collected on recent fever, body temperature, and malaria parasites. Participants were assigned a clinical stage at each routine visit and had regular CD4-cell measurements.FINDINGS:
484 participants made 7220 routine clinic visits between 1990 and 1998. Parasitaemia was more common at visits by HIV-1-positive individuals (328 of 2788 [11.8%] vs 231 of 3688 [6.3%], p<0.0001). At HIV-1-positive visits, lower CD4-cell counts were associated with higher parasite densities, compared with HIV-1-negative visits (p=0.0076). Clinical malaria was significantly more common at HIV-1-positive visits (55 of 2788 [2.0%] vs 26 of 3688 [0.7%], p=0.0003) and the odds of having clinical malaria increased with falling CD4-cell count (p=0.0002) and advancing clinical stage (p=0.0024). Participants made 3377 interim visits. The risk of clinical malaria was significantly higher at visits by HIV-1-positive individuals than HIV-1-negative individuals (4.0% vs 1.9%, p=0.009). The risk of clinical malaria tended to increase with falling CD4-cell counts (p=0.052).INTERPRETATION:
HIV-1 infection is associated with an increased frequency of clinical malaria and parasitaemia. This association tends to become more pronounced with advancing immunosuppression, and could have important public-health implications for sub-Saharan Africa.Palavras-chave
Africa; Africa South Of The Sahara; Biology; Demographic Factors; Developing Countries; Diseases; Eastern Africa; English Speaking Africa; Hiv Infections; Immunity; Immunological Effects; Malaria; Parasitic Diseases; Physiology; Population; Population Characteristics; Research Report; Rural Population; Uganda; Viral Diseases
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
HIV-1
/
Terapia de Imunossupressão
/
Malária Falciparum
Tipo de estudo:
Etiology_studies
/
Incidence_studies
/
Observational_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
/
Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Revista:
Lancet
Ano de publicação:
2000
Tipo de documento:
Article