马拉维重度贫血儿童中疟疾与人类免疫缺陷病毒感染之间的相互作用：一项前瞻性纵向研究。

The interaction between malaria and human immunodeficiency virus infection in severely anaemic Malawian children: a prospective longitudinal study.

作者信息

Kyeyune Francis X, Calis Job C J, Phiri Kamija S, Faragher Brian, Kachala David, Brabin Bernard J, van Hensbroek Michaël Boele

机构信息

Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK.

Global Child Health Group, Emma Children's Hospital AMC, Amsterdam, the Netherlands.

出版信息

Trop Med Int Health. 2014 Jun;19(6):698-705. doi: 10.1111/tmi.12295. Epub 2014 Mar 17.

DOI:10.1111/tmi.12295

PMID:24628893

Abstract

OBJECTIVE

Malaria and human immunodeficiency virus (HIV) infection are co-prevalent in sub-Saharan Africa and cause severe anaemia in children. Interactions between these infections occur in adults, although these are less clear in children. The aim of study was to determine their interaction in a cohort of severely anaemic children.

METHODS

Severely anaemic Malawian children were enrolled, tested for HIV and malaria, transfused and followed for 18 months for malaria incidence. Antiretrovirals were not widely available in Malawi during the study period.

RESULTS

Of 381 children (haemoglobin <5 g/dl), 357 consented for HIV testing, 12.6% were HIV-infected, and 59.5% had malaria parasitaemia. At enrolment, HIV-infected children had similar malaria parasitaemia prevalence (59.1% vs. 58.7%; P = 0.96) and parasite density (geometric mean [parasites/μl] 6903 vs. 12417; P = 0.18) as HIV-negative children. There were no differences in mean CD4%, or prevalence of severe immunosuppression, between those with and without malaria parasitaemia. Plasma viral load correlated negatively with log parasitaemia (r = -0.78; P = 0.01). During follow-up, HIV-infected children did not experience more frequent parasitaemias or symptomatic malaria episodes. Adjusted risk estimates (95% CI) for malaria parasitaemia in HIV-infected children at 6 and 18 months follow-up were 0.39 (0.13-1.14) and 0.40 (0.11-1.51), respectively.

CONCLUSIONS

Severely anaemic HIV-infected children showed no increased susceptibility to asymptomatic or symptomatic malaria during or following their anaemic episode, although all experienced lower parasite prevalence during follow-up. This contrasts with data in adults and may relate to the malaria immunity of young children which is insufficiently developed to be impaired by HIV. The negative correlation between viral load and malaria parasitaemia remains unexplained.

摘要

目的

疟疾和人类免疫缺陷病毒（HIV）感染在撒哈拉以南非洲地区共同流行，并导致儿童严重贫血。这些感染在成年人中会相互作用，尽管在儿童中情况尚不清楚。本研究的目的是确定它们在一组严重贫血儿童中的相互作用。

方法

招募严重贫血的马拉维儿童，检测其HIV和疟疾，进行输血治疗，并随访18个月以观察疟疾发病率。在研究期间，抗逆转录病毒药物在马拉维尚未广泛使用。

结果

在381名儿童（血红蛋白<5g/dl）中，357名同意进行HIV检测，12.6%的儿童感染了HIV，59.5%的儿童有疟疾寄生虫血症。在入组时，感染HIV的儿童与未感染HIV的儿童相比，疟疾寄生虫血症患病率相似（59.1%对58.7%；P = 0.96），寄生虫密度也相似（几何平均数[寄生虫/μl]分别为6903和12417；P = 0.18）。有无疟疾寄生虫血症的儿童之间，平均CD4%或严重免疫抑制的患病率没有差异。血浆病毒载量与对数寄生虫血症呈负相关（r = -0.78；P = 0.01）。在随访期间，感染HIV的儿童没有经历更频繁的寄生虫血症或有症状的疟疾发作。在6个月和18个月随访时，感染HIV儿童发生疟疾寄生虫血症的校正风险估计值（95%可信区间）分别为0.39（0.13 - 1.14）和0.40（0.11 - 1.51）。