Prevalence and clinical features of HIV and malaria co-infection in hospitalized adults in Beira, Mozambique
Saracino, A.; Nacarapa, E.A.; da Costa Massinga, E.A.; Martinelli, D.; Scacchetti, M.; de Oliveira, C.; Antonich, A.; Galloni, D.; Ferro, J.J.; Macome, César.A.
Malaria Journal 11: 241
2012
ISSN/ISBN: 1475-2875 PMID: 22835018 DOI: 10.1186/1475-2875-11-241Document Number: 566264
Mozambique presents a very high prevalence of both malaria and HIV infection, but theimpact of co-infection on morbidity in this population has been rarely investigated. The aimof this study was to describe the prevalence and clinical characteristics of malaria inhospitalized adult HIV-positive patients, treated and untreated with combination antiretroviraltherapy (ART) and cotrimoxazole (CTX)-based chemoprophylaxis, compared toHIV negatives. From November to December 21, all adult patients consecutively admitted to theDepartment of Internal medicine of Beira Central Hospital, Sofala Province, Mozambique,were submitted to HIV testing, malaria blood smear (MBS) and, in a subgroup of patients,also to the rapid malaria test (RDT). Socio-demographical and clinical data were collected forall patients. The association of both a positive mBS and/or RDT and diagnosis of clinicalmalaria with concomitant HIV infection (and use of CTX and/or ART) was assessedstatistically. Frequency of symptoms and hematological alterations in HIV patients withclinical malaria compared to HIV negatives was also analysed. Sensitivity and specificity forRDT versus mBS were calculated for both HIV-positive and negative patients. A total of 33 patients with available HIV test and mBS were included in the analysis, 22 ofwhom (66.7%) were HIV-positive. In 93 patients, malaria infection was documented by mBSand/or RDT. RDT sensitivity and specificity were 94% and 96%, respectively. According tolaboratory results, the initial malaria suspicion was discarded in about 1% of cases, with nodifferences between HIV-positive and negative patients. A lower malaria risk wassignificantly associated with CTX prophylaxis (p=.2), but not with ART based on nonnucleoside reverse-transcriptase inhibitors (NNRTIs). Overall, severe malaria seemed to bemore common in HIV-positive patients (61.7%) compared to HIV-negatives (47.2%), while asignificantly lower haemoglobin level was observed in the group of HIV-positive patients(9.9+/-2.8mg/dl) compared to those HIV-negative (12.1+/-2.8mg/dl) (p=.3). Malaria infection was rare in HIV-positive individuals treated with CTX for opportunisticinfections, while no independent anti-malarial effect for NNRTIs was noted. When HIV andmalaria co-infection occurred, a high risk of complications, particularly anaemia, should beexpected.