HIV/Malaria co-infection: Effect of HIV infection on antimalarial treatment outcomes in children in Zambia

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Mwale-Mutengo, Mable
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Children co-infected with HIV-1 and malaria are more likely to suffer from malaria and may respond poorly to anti-malarial treatment due to immunosuppression resulting from HIV infection. This study provides results of antimalarial treatment outcomes in children co-infected with HIV and malaria. The study was a health facility based case control study and was conducted between December 2006 and October 2007. One hundred and twenty four children were recruited from five study sites with stable and unstable malaria transmission patterns. Among the 124 children recruited, 9 had HIV-1 and malaria co-infections (cases) while 113 were non-HIV-1 and malaria infected (controls). Treatment was according to the Zambian government malaria treatment policy guidelines; thus Quinine for complicated malaria and Artemether Lumefantrine (Coartem) for uncomplicated malaria. All the children recruited were followed-up for 28 days. Eighty children completed the day 28 follow-up. Clinical assessment and malaria parasite examination were done on each day of the visit while samples for PCR were collected on day 14 and any day thereafter if the patient was malaria positive by blood slide. Molecular genotyping was used to distinguish re-infection parasites from recrudescent parasites. Data was analyzed with SPSS version 11.0. Chi-square test was used to test for significant differences of baseline data among the two groups and the difference in means was measured with the unpaired t-test. Tests of significance could not be performed on treatment outcomes because of the low numbers of patients in the case group. Out of the 80 children who completed day 28 follow-up, 8 were cases and 72 were controls. The mean haemoglobin levels among children in the case and control groups at baseline was 6.62 ±2.71 and 9.55±2.40 respectively (p-value <0.05). The parasite count geometric means for the case and control groups were 11501 and 7550 respectively. The mean CD4 counts for the children in the case group 356± 138.47 while the control had 1171.86±445.18 (p-value <0.05). Fifty percent of the cases presented with complicated malaria upon recruitment as compared to 6.9% in the controls. A total of 16 post treatment positive samples were recorded of which 4 were positive by both microscopy and 12 were positive by PCR only. In order to distinguish re-infection parasites from recrudescent, all the 16 positive post treatment samples were genotyped. Out of the 16 post treatment malaria positive samples recorded, 5 (31.3%) were due to re-infections and 10 (62.5%) were recrudescents. Recrudescent parasites were seen in 6.2% and 62.5% of the cases and controls respectively. Treatment failure rates within the case and control groups were I (12.5%) and 10 (13.8%) respectively. Our study has documented higher parasitaemia and prevalence of severe malaria among HIV-1 malaria co-infected children. However, the study findings have shown that the risk of developing treatment failure is less likely among children with severe immunosuppression as seen in HIV malaria infected children. These results may not be significant and conclusive due to a number of factors including the low prevalence rates of HIV and malaria co-infections and small study sample size.
Malaria- - Zambia , HIV- - Zambia