The effect of Plasmodium falciparum malaria on HIV-1 RNA blood plasma concentration

Objectives: This study was undertaken to determine the relative effect of m alaria infection on HIV concentration in blood plasma, and prospectively to monitor viral concentrations after antimalarial therapy. Design: A prospective, double cohort study was designed to compare the bloo d HIV-1 RNA concentrations of HIV-positive individuals with and without acu te malaria illness. Subjects were followed for 4 weeks after successful mal aria therapy, or for 4 weeks from enrollment (controls). Methods: Malawian adults with symptomatic Plasmodium falciparum parasitemia (malaria group) and asymptomatic, aparasitemic blood donors (control group ) were tested for HIV-1 antibodies to identify appropriate study groups. Th e malaria group received antimalarial chemotherapy only and were followed w ith sequential blood films. In both groups, blood plasma HIV-1 RNA viral co ncentrations were determined at enrollment and again at 1, 2 and 4 weeks. Results: Forty-seven malaria patients and 42 blood donors were enrolled. At enrollment blood plasma HIV-1 RNA concentrations were approximately sevenf old higher in patients with malaria than in blood donors (medians 15.1 x 10 (4) and 2.24 x 10(4) copies/ml, respectively, P = 0.0001). No significant c hanges in median HIV-1 concentrations occurred in the 21 blood donors follo wed to week 4 (P = 0.68). In the 27 subjects successfully treated for malar ia who were followed to week 4, a reduction in plasma HIV-1 RNA was observe d from a median of 19.1 x 10(4) RNA copies/ml at enrollment, to 12.0 x 10(4 ) copies/ml at week 4, (P = 0.02). Plasma HIV-1 concentrations remained hig her in malaria patients than controls (median 12.0 x 10(4) compared with 4. 17 x 10(4) copies/ml, P = 0.086). Conclusions: HIV-1 blood viral burden is higher in patients with P. falcipa rum malaria than in controls and this viral burden can, in some patients, b e partly reduced with antimalarial therapy. (C) 1999 Lippincott Williams & Wilkins.