Okonkwo Ikechukwu R, Ibadin Michael O, Omoigberale Austin I, Sadoh Wilson E
Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria.
J Pediatric Infect Dis Soc. 2016 Mar;5(1):21-8. doi: 10.1093/jpids/piu093. Epub 2014 Oct 17.
Human immunodeficiency virus (HIV) infection and Plasmodium falciparum malaria are 2 of the gravest health threats in sub-Saharan Africa. Multiple repeat infections with the malaria parasite as seen in endemic areas are necessary to develop specific malaria immunity. HIV is an immunosuppressive virus and in children aged <5 years, development of malaria-specific immunity may be impaired and malaria parasite clearance in theory will be delayed; hence the predisposition to increased incidence of asymptomatic malaria or severe malaria. This cross-sectional study was carried out to examine associations between immunosuppression and asymptomatic malaria parasitemia (ASMP) in HIV-infected children aged <5 years in Benin City.
One hundred seventy-nine asymptomatic HIV-1-positive and 179 age- and sex-matched HIV-1-negative children aged <5 years were recruited. The malaria parasite was determined by Giemsa-stained blood film by certified microscopy while concomitant CD4(+) count was estimated in the HIV-infected children.
The prevalence of ASMP in those who were HIV-infected of 34.1% was significantly higher than 17.3% in the HIV uninfected (P = .001). The prevalence of ASMP was highest (59.3%) among subjects who were severely immunosuppressed (CDC immunologic category 3). The prevalence of ASMP significantly increased with advanced immune disease in the subjects (P = .011). Severe (World Health Organization) clinical staging was also significantly associated with increased prevalence of ASMP (P = .031). The prevalence of ASMP is significantly higher among subjects not receiving cotrimoxazole, associated with threefold risk of having ASMP (P = .003: odds ratio = 3.5).
ASMP is more common in HIV-positive children aged <5 years and is significantly associated with declining CD4(+) T-cell count and severe clinical disease. There is a need for integration of HIV- and malaria-control programs for stronger case management. Malaria-control programs may consider malaria prevention interventions and cotrimoxazole prophylaxis for preschool children who are HIV-infected and living in malaria-endemic regions.
人类免疫缺陷病毒（HIV）感染和恶性疟原虫疟疾是撒哈拉以南非洲最严重的两大健康威胁。在疟疾流行地区，多次重复感染疟原虫是产生特异性疟疾免疫力所必需的。HIV是一种免疫抑制病毒，在5岁以下儿童中，疟疾特异性免疫力的发展可能会受到损害，理论上疟原虫清除也会延迟；因此，无症状疟疾或重症疟疾发病率增加的易感性也会增强。本横断面研究旨在调查贝宁城5岁以下HIV感染儿童免疫抑制与无症状疟疾寄生虫血症（ASMP）之间的关联。
招募了179名无症状HIV-1阳性和179名年龄及性别匹配的5岁以下HIV-1阴性儿童。通过经认证的显微镜检查吉姆萨染色血片来确定疟原虫，同时对HIV感染儿童的CD4(+)细胞计数进行估算。
HIV感染儿童中ASMP的患病率为34.1%，显著高于未感染HIV儿童的17.3%（P = 0.001）。在严重免疫抑制（疾病控制中心免疫类别3）的受试者中，ASMP的患病率最高（59.3%）。随着受试者免疫疾病的进展，ASMP的患病率显著增加（P = 0.011）。严重（世界卫生组织）临床分期也与ASMP患病率增加显著相关（P = 0.031）。未接受复方新诺明治疗的受试者中ASMP的患病率显著更高，患ASMP的风险增加了三倍（P = 0.003：比值比 = 3.5）。
ASMP在5岁以下HIV阳性儿童中更为常见，且与CD4(+) T细胞计数下降和严重临床疾病显著相关。需要整合HIV和疟疾控制项目，以加强病例管理。疟疾控制项目可考虑对感染HIV且生活在疟疾流行地区的学龄前儿童采取疟疾预防干预措施和复方新诺明预防治疗。
