Departments of Medicine.
Division of Infectious Diseases , Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts.
Open Forum Infect Dis. 2014 Aug 21;1(2):ofu066. doi: 10.1093/ofid/ofu066. eCollection 2014 Sep.
Plasmodium falciparum infection has been reported to increase human immunodeficiency virus (HIV) viral load (VL), which can facilitate HIV transmission. We prospectively studied the impact of mild P falciparum coinfection on HIV VL in Rwanda.
We measured plasma HIV VL at presentation with malaria infection and weekly for 4 weeks after artemether-lumefantrine treatment in Rwandan adults infected with HIV with P falciparum malaria. Regression analyses were used to examine associations between malaria infection and HIV VL changes. Samples with detectable virus underwent genotypic drug-resistance testing.
We enrolled 28 HIV-malaria coinfected patients and observed 27 of them for 5 weeks. Three patients (11%) were newly diagnosed with HIV. Acute P falciparum infection had no significant effect on HIV VL slope over 28 days of follow-up. Ten patients with VL <40 copies/mL at enrollment maintained viral suppression throughout. Seventeen patients had a detectable VL at enrollment including 9 (53%) who reported 100% adherence to ARVs; 3 of these had detectable genotypic drug resistance.
Unlike studies from highly malaria-endemic areas, we did not identify an effect of P falciparum infection on HIV VL; therefore, malaria is not likely to increase HIV-transmission risk in our setting. However, routine HIV testing should be offered to adults presenting with acute malaria in Rwanda. Most importantly, we identified a large percentage of patients with detectable HIV VL despite antiretroviral (ARV) therapy. Some of these patients had HIV genotypic drug resistance. Larger studies are needed to define the prevalence and factors associated with detectable HIV VL in patients prescribed ARVs in Rwanda.
已报道疟原虫感染可增加人类免疫缺陷病毒（HIV）病毒载量（VL），从而促进 HIV 传播。我们前瞻性研究了温和的恶性疟原虫合并感染对卢旺达 HIV 病毒载量的影响。
我们在感染 HIV 的成年疟疾患者出现疟疾感染时和青蒿琥酯-咯萘啶治疗后每周测量血浆 HIV VL，共 4 周。回归分析用于检查疟疾感染与 HIV VL 变化之间的关联。可检测到病毒的样本进行了基因型耐药性检测。
我们共纳入 28 例 HIV-疟疾合并感染患者，观察了其中 27 例 5 周。3 例（11%）患者新诊断为 HIV。急性恶性疟原虫感染对 28 天随访期间 HIV VL 斜率无显著影响。10 例在入组时 VL<40 拷贝/ml 的患者整个随访期间均保持病毒抑制。17 例在入组时 VL 可检测到，其中 9 例（53%）报告了 100%抗逆转录病毒药物（ARV）依从性；其中 3 例具有可检测的基因型耐药性。
与高疟疾流行地区的研究不同，我们未发现恶性疟原虫感染对 HIV VL 的影响；因此，疟疾在我们的环境中不太可能增加 HIV 传播风险。然而，应向在卢旺达出现急性疟疾的成年人提供常规 HIV 检测。最重要的是，我们发现尽管接受了抗逆转录病毒（ARV）治疗，仍有很大比例的患者 HIV VL 可检测到。其中一些患者具有 HIV 基因型耐药性。需要更大规模的研究来确定在卢旺达接受 ARV 治疗的患者中可检测到 HIV VL 的患病率和相关因素。
