Doctors with Africa CUAMM-Mozambique, Beira, Mozambique.
Malar J. 2012 Jul 26;11:241. doi: 10.1186/1475-2875-11-241.
Mozambique presents a very high prevalence of both malaria and HIV infection, but the impact of co-cancel infection on morbidity in this population has been rarely investigated. The aim of this study was to describe the prevalence and clinical characteristics of malaria in hospitalized adult HIV-positive patients, treated and untreated with combination anti-retroviral therapy (ART) and cotrimoxazole (CTX)-based chemoprophylaxis, compared to HIV negatives.
From November to December 2010, all adult patients consecutively admitted to the Department of Internal Medicine of Beira Central Hospital, Sofala Province, Mozambique, were submitted to HIV testing, malaria blood smear (MBS) and, in a subgroup of patients, also to the rapid malaria test (RDT). Socio-demographical and clinical data were collected for all patients. The association of both a positive MBS and/or RDT and diagnosis of clinical malaria with concomitant HIV infection (and use of CTX and/or ART) was assessed statistically. Frequency of symptoms and hematological alterations in HIV patients with clinical malaria compared to HIV negatives was also analysed. Sensitivity and specificity for RDT versus MBS were calculated for both HIV-positive and negative patients.
A total of 330 patients with available HIV test and MBS were included in the analysis, 220 of whom (66.7%) were HIV-positive. In 93 patients, malaria infection was documented by MBS and/or RDT. RDT sensitivity and specificity were 94% and 96%, respectively. According to laboratory results, the initial malaria suspicion was discarded in about 10% of cases, with no differences between HIV-positive and negative patients. A lower malaria risk was significantly associated with CTX prophylaxis (p=0.02), but not with ART based on non nucleoside reverse-transcriptase inhibitors (NNRTIs). Overall, severe malaria seemed to be more common in HIV-positive patients (61.7%) compared to HIV-negatives (47.2%), while a significantly lower haemoglobin level was observed in the group of HIV-positive patients (9.9 ± 2.8 mg/dl) compared to those HIV-negative (12.1 ± 2.8 mg/dl) (p=0.003).
Malaria infection was rare in HIV-positive individuals treated with CTX for opportunistic infections, while no independent anti-malarial effect for NNRTIs was noted. When HIV and malaria co-infection occurred, a high risk of complications, particularly anaemia, should be expected.
莫桑比克疟疾和 HIV 感染的流行率都非常高，但合并感染对该人群发病率的影响很少被研究。本研究的目的是描述在接受抗逆转录病毒治疗（ART）和复方磺胺甲噁唑（CTX）为基础的化学预防治疗以及未接受治疗的住院成人 HIV 阳性患者中疟疾的流行率和临床特征，并与 HIV 阴性患者进行比较。
2010 年 11 月至 12 月期间，莫桑比克贝拉中央医院内科连续收治的所有成年患者均接受 HIV 检测、疟疾血涂片（MBS）检查，并且在患者亚组中还进行了快速疟疾检测（RDT）。收集所有患者的社会人口统计学和临床数据。统计分析 MBS 和/或 RDT 阳性与临床疟疾诊断与同时感染 HIV（以及使用 CTX 和/或 ART）之间的关系。还分析了 HIV 阳性患者与 HIV 阴性患者临床疟疾的症状和血液学改变的频率。计算了 RDT 对 HIV 阳性和阴性患者的 MBS 的敏感性和特异性。
共纳入 330 例有 HIV 检测和 MBS 结果的患者进行分析，其中 220 例（66.7%）为 HIV 阳性。93 例患者的疟疾感染通过 MBS 和/或 RDT 得到证实。RDT 的敏感性和特异性分别为 94%和 96%。根据实验室结果，约 10%的病例最初怀疑疟疾，但 HIV 阳性和阴性患者之间没有差异。CTX 预防显著降低疟疾风险（p=0.02），但基于非核苷类逆转录酶抑制剂（NNRTIs）的 ART 则不然。总的来说，HIV 阳性患者中严重疟疾似乎更为常见（61.7%），而 HIV 阴性患者中则更为常见（47.2%），同时 HIV 阳性患者的血红蛋白水平显著低于 HIV 阴性患者（9.9 ± 2.8 mg/dl）（p=0.003）。
CTX 治疗机会性感染的 HIV 阳性个体中疟疾感染罕见，而 NNRTIs 没有独立的抗疟作用。当 HIV 和疟疾合并感染时，应高度警惕发生并发症，特别是贫血。
