IS THERE AN INTERACTION BETWEEN HUMAN-IMMUNODEFICIENCY-VIRUS AND PLASMODIUM-FALCIPARUM

Background There is a potential for interaction between malaria and hu man immunodeficiency virus (HIV) infection. HIV infection might reduce immunity to malaria resulting in more frequent and severe infections; conversely malaria might enhance the progression of HIV infection to AIDS. in this paper we have reviewed some of the studies that have add ressed this topic. Methods Studies identified by a MEDLINE search were systematically reviewed and the measures of association between the t wo infections were either abstracted or recalculated from the reported data. Inferences drawn from these studies and the biological plausibi lity of an interaction are discussed. Results The prevalence ratio (PR ) of peripheral parasitaemia among HIV seropositive (HIVSP) individual s compared to HIV seronegative (HIVSN) individuals ranged from 0.72 to 0.94 in children and from 3.3 to 0.69 in adults. However, only one st udy showed a statistically significant difference between HIVSP and HI VSN groups (PR 3.3, 95% CI : 2.7-4.2). The rate ratio of non-severe ma laria among HIVSP children compared to HIVSN children was 1.4 (95% CI : 0.99-2.0). Data from a trial of chemoprophylaxis during pregnancy su ggested that placental malaria may predispose to perinatal transmissio n of HIV. Studies that have investigated the immune response to P. fal ciparum among HIVSP subjects have given variable results. Conclusion T here is no convincing evidence for an interaction between malaria and HIV with the possible exception of an interaction between placental ma laria and HIV infection. Several studies, however, had potentials for bias and/or an inadequate sample size. There is a need for carefully d esigned studies to resolve whether mortality from severe malaria, in p articular cerebral malaria, is increased in HIVSP subjects, whether ma laria infection of the placenta increases the risk of vertical transmi ssion of HIV, and whether malaria infection increases the progression of HIV infection to AIDS.