Malaria and HIV are among the most prevalent infectious diseases in sub-Saharan Africa and co-infections are common. HIV-associated immunosuppression increases the prevalence and severity of malaria (van Eijk, 2003) (Whitworth, 2000) (Francesconi, 2001) and malaria is associated with an increase in viral load in pregnant women (Mwapasa, 2004) (ter Kuile, 2004). Malaria and HIV co-infection has also been shown to increase mother-to-child HIV transmission (Brahmbhatt, 2003) (Ayisi, 2004). A study in Malawi found that malaria co-infection increased HIV-viral load and the increase was more significant among individuals with severe clinical malaria and individuals who were immunosuppressed (CD4<300 cells per uL) (Kublin, 2005). A discordant couple study in Rakai, Uganda showed the viral load to be the primary predictor of risk of heterosexual transmission of HIV, and transmission is rare among individuals whose viral loads are <1,500 copies of HIV-RNA per mL (Quinn, 2000). It is important to corroborate the Malawi study and examine the effect of malaria on the concentration of HIV-RNA. This study tests specimens from Rakai for malaria and assesses the relationship to HIV viral load and heterosexual transmission risk. Investigators: References: van Eijk AM, Ayisi JG, ter Kuile FO, Misore AO, Otieno JA, Rosen DH, Kager PA, Steketee RW, Nahlen BL. HIV increases the risk of malaria in women of all gravidities in Kisumu, Kenya. AIDS. 2003 Mar 7;17(4):595-603. Whitworth J, Morgan D, Quigley M, Smith A, Mayanja B, Eotu H, Omoding N, Okongo M, Malamba S, Ojwiya A. Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study. Lancet. 2000 Sep 23;356(9235):1051-6. Francesconi P, Fabiani M, Dente MG, Lukwiya M, Okwey R, Ouma J, Ochakachon R, Cian F, Declich S. HIV, malaria parasites, and acute febrile episodes in Ugandan adults: a case-control study. AIDS. 2001 Dec 7;15(18):2445-50. Mwapasa V, Rogerson SJ, Molyneux ME, Abrams ET, Kamwendo DD, Lema VM, Tadesse E, Chaluluka E, Wilson PE, Meshnick SR. The effect of Plasmodium falciparum malaria on peripheral and placental HIV-1 RNA concentrations in pregnant Malawian women. AIDS. 2004 Apr 30;18(7):1051-9. ter Kuile FO, Parise ME, Verhoeff FH, Udhayakumar V, Newman RD, van Eijk AM, Rogerson SJ,Steketee RW. The burden of co-infection with human immunodeficiency virus type 1 and malaria in pregnant women in sub-saharan Africa. Am J Trop Med Hyg. 2004 Aug;71(2 Suppl):41-54. Brahmbhatt H, Kigozi G, Wabwire-Mangen F, Serwadda D, Sewankambo N, Lutalo T, Wawer MJ, Abramowsky C, Sullivan D, Gray R. The effects of placental malaria on mother-to-child HIV transmission in Rakai, Uganda. AIDS. 2003 Nov 21;17(17):2539-41. Ayisi JG, van Eijk AM, Newman RD, ter Kuile FO, Shi YP, Yang C, Kolczak MS, Otieno JA, Misore AO, Kager PA, Lal RB, Steketee RW, Nahlen BL. Maternal malaria and perinatal HIV transmission, western Kenya. Emerg Infect Dis.2004 April;10(4):643-52. Kublin JG, Patnaik P, Jere CS, Miller WC, Hoffman IF, Chimbiya N, Pendame R, Taylor TE, Molyneux ME. Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi: a prospective cohort study. Lancet. 2005 Jan 15-21;365(9455):233-40. Quinn TC, Wawer MJ, Sewankambo N, Serwadda D, Li C, Wabwire-Mangen F, Meehan MO, Lutalo T, Gray RH. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000 Mar 30;342(13):921-9. |
