Malaria and HIV co-infection: Available evidence, gaps and possible interventions

Abstract

Objectives: To review the evidence of association between malaria and HI V/AIDS co-infection for purposes of developing strategies for malaria control. Design: Desktop review of literature. Setting: Harare, Zimbabwe. Main Outcome Measures: Response to treatment, development of severe malaria, malarial immunological response in HIV/AIDS positive people and incidence of malaria in HIV,'AIDS positive individuals. Results: HIV-1 infection increases the incidence q{ Plasmodium falciparum parasitaemia and is associated with the development of severe malaria, commonly anaemia, cerebral malaria and high parasite density (OR=2.56; 95% CI= 1.53 to 4.29; pcO.OOl). The efficacy of chloroquine and sulphadoxine-pyrimethamine in reducing placental malaria in HIV-1 positive pregnant women was impaired compared to HIV-I negative pregnant women. However, the situation in non-gravid HIV-1 positive people as regards efficacy of chloroquine and sulphadoxine-pyrimethamine prophylaxis is not known. Also not known is the relationship between malaria parasitaemia without symptoms and HIV-1 infection, the results of which may provide useful information regarding malaria control and prevention in HIV-1 positive people. Con elusions: HIV-1 positive people staying in malaria endemic areas are at risk of developing severe malaria. Malaria prevention using insecticide-treated bed nets and indoor residual house spraying may be the best available options for these people. Chloroquine and sulphadoxine-pyrimethamine prophylaxis require further studies to verify their efficacy, in the presence of H1V-1/A1DS infection.