Grimwade Kate, French Neil, Mbatha Daniel D, Zungu Dawn D, Dedicoat Martin, Gilks Charles F
Hlabisa Hospital, KwaZulu-Natal, South Africa.
Pediatr Infect Dis J. 2003 Dec;22(12):1057-63. doi: 10.1097/01.inf.0000101188.95433.60.
Malaria and HIV are important pediatric problems in sub-Saharan Africa. It is uncertain how HIV-related immunosuppression and malaria interact in children. We aimed to describe associations among HIV status, presentation and outcome from malaria in children from Hlabisa district, KwaZulu-Natal, South Africa, a region of high HIV prevalence and unstable Plasmodium falciparum transmission.
Consecutive febrile children were screened for malaria with a rapid antigen test. After consent was given, clinical data were recorded, and blood spots were obtained for HIV antibody testing. Cases were managed according to national guidelines.
Malaria was diagnosed in 663 children, of whom 10.1% were HIV antibody-positive. Semiquantitative asexual and sexual stage parasitemia densities were unrelated to HIV status. Overall 161 children were hospitalized; 19 (12%) were <1 year old; and 41 (25%) had severe/complicated malaria. Severe disease presented more frequently in HIV antibody-positive than in HIV-uninfected children (P = 0.05), particularly in those >1 year old with coma (P = 0.02) and hypoglycemia (P = 0.05). Receiving parenteral antibiotics was associated with severe disease (odds ratio, 3.0; 95% confidence interval, 1.3 to 6.7) whereas a low white blood cell count (<4 x 10(6)/l) was associated with nonsevere disease (odds ratio, 0.4; 95% confidence interval, 0.2 to 0.8). Seven children (4.3%) died. Coma, age <1 year and low white blood cell count were the clearest predictors of poor outcome.
HIV infection was associated with severe/complicated malaria, although the magnitude of the effect may be relatively small. Given that both malaria and HIV are widespread in Africa, even small effects may generate significant morbidity and mortality and major public health consequences.
疟疾和艾滋病毒是撒哈拉以南非洲地区重要的儿科问题。儿童中艾滋病毒相关免疫抑制与疟疾如何相互作用尚不确定。我们旨在描述南非夸祖鲁 - 纳塔尔省赫拉比萨区儿童的艾滋病毒感染状况、疟疾表现及转归之间的关联，该地区艾滋病毒感染率高且恶性疟原虫传播不稳定。
对连续的发热儿童进行快速抗原检测以筛查疟疾。获得同意后，记录临床数据，并采集血斑进行艾滋病毒抗体检测。病例按照国家指南进行管理。
663名儿童被诊断为疟疾，其中10.1%艾滋病毒抗体呈阳性。无性和有性阶段疟原虫血症的半定量密度与艾滋病毒感染状况无关。总体上161名儿童住院；19名（12%）年龄小于1岁；41名（25%）患有严重/复杂疟疾。艾滋病毒抗体阳性儿童比未感染艾滋病毒的儿童严重疾病发生率更高（P = 0.05），特别是在1岁以上出现昏迷（P = 0.02）和低血糖（P = 0.05）的儿童中。接受静脉抗生素治疗与严重疾病相关（比值比，3.0；95%置信区间，1.3至6.7），而白细胞计数低（<4×10⁶/l）与非严重疾病相关（比值比，0.4；95%置信区间，0.2至0.8）。7名儿童（4.3%）死亡。昏迷、年龄小于1岁和白细胞计数低是不良转归最明显的预测因素。
艾滋病毒感染与严重/复杂疟疾相关，尽管影响程度可能相对较小。鉴于疟疾和艾滋病毒在非洲都广泛流行，即使是小的影响也可能产生显著的发病率和死亡率以及重大的公共卫生后果。
