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An investigation of interactions between HIV and malaria in non-immune malaria patients
Rationale
Highly active antiretroviral therapy (HAART) has significantly reduced AIDS morbidity and mortality. As a consequence of prolonged AIDS-free time and improved living conditions the number of HIV-patients travelling to malarious areas can be expected to rise. Pre-travel counselling is especially important for travellers with compromised immune status, however little is known about the interaction between HIV and malaria so far.
On one hand HIV infection causes increasing celluar immunosuppression and could thus result in an impaired immune response to malaria, leading to failure to prevent infection or suppress parasitaemia and clinical disease.
On the other hand Plasmodium falciparum has been shown to stimulate HIV replication through the production of cytokines by activated lymphocytes. HIV proviral loads are significantly higher in patients with malaria than those without and remain higher for several weeks after treatment. Thus malaria could cause faster progression of HIV disease. Former studies from Africa have shown conflicting results and for the moment there is no existing study on non-immune patients under HAART.
Research questions / objectives
- Does falciparum malaria infection exert an unfavourable effect on HIV viral loads and CD4 counts of HIV-patients under various HAART regimes?
- Does HIV infection have unfavourable effects on the course of falciparum malaria (parasite clearance, therapeutic failures, complications)?
Study design
Study type
Prospective case series
To muster HIV-patients without malaria is considered difficult in our network setting. Therefore no data will be raised on viral load variation in HIV-patients without malaria.
However, malaria patients without HIV co-infection could be sampled from the TropNet patient pool to assess comparative data on CD4 count development, parasite clearance, treatment failure and complications in the absence of HIV co-infection.
Study population
Minimum of 20 non-immune patients with falciparum malaria and HIV co-infection
Sampling period
2001-2004. This means two years retrospectively and two years prospectively. Because we have already registered about 8 patients with this co-infection in TropNet.