Increasing rates of malarial fever with deteriorating immune status in HIV-1-infected Ugandan adults

Background: Falciparum malaria and HIV-1 infection are two of the most impo rtant health problems facing sub-Saharan Africa. No convincing evidence of an association between symptomatic malaria and HIV-1 infection has been fou nd. Objective: To investigate the effect of HIV-associated immunosuppression on malarial fever rates. Design: An observational cohort study in HIV-specific, primary healthcare c linics in Entebbe, Uganda, on 1371 HIV-1-infected adults participating in a randomized trial of 23-valent pneumococcal vaccine. Methods: Cohort members underwent routine 6 monthly surveillance and had op en clinic access when sick. Episodes of fever were assessed according to st andardized protocols. Rates of malaria are described according to HIV immun e status determined by CD4 T cell counts. Results: Incidence rates of Plasmodium falciparum malarial fever showed a m arked inverse relationship with CD4 T cell count; 140, 93 and 57 cases per 1000 pyo for CD4 T cell groups < 200, 200-499 and > 500 respectively, P< 0. 001. Malarial fever definitions incorporating parasite density criteria (de rived from asymptomatic surveillance) to correct for chance findings of fev er and P. falciparum parasitaemia, did not affect the association of incide nce rates with immunosuppression. Conclusion: These data support an interaction between symptomatic P. falcip arum and HIV. Emphasis on mosquito avoidance measures should be an importan t component of education and counselling of HIV/AIDS patients in malaria-en demic areas, and suggests an additional HIV-related public health problem i n Africa. (C) 2001 Lippincott Williams & Wilkins.