加纳阿克拉低传播地区儿童艾滋病毒感染者无症状疟原虫血症和病毒学未抑制的横断面研究。

Asymptomatic malaria parasitaemia and virological non-suppression among children living with HIV in a low transmission area in Accra, Ghana: a cross-sectional study.

机构信息

Department of Child Health, University of Ghana Medical School, Accra, Ghana.

Department of Biostatistics, School of Public Health, University of Ghana, Legon, Accra, Ghana.

出版信息

BMC Infect Dis. 2024 Oct 11;24(1):1144. doi: 10.1186/s12879-024-09974-x.

DOI:10.1186/s12879-024-09974-x

PMID:39394078

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11470549/

Abstract

BACKGROUND

Human Immunodeficiency Virus (HIV) and malaria are two major diseases in sub-Saharan Africa. Co-infection can significantly impact the clinical outcomes of both conditions. We assessed the proportion of HIV-infected children at Korle Bu Teaching Hospital (KBTH) and Princess Marie Louise Hospital (PML) with malaria parasites. The association between asymptomatic malaria parasitaemia and virological non-suppression was also determined in these children.

METHODS

This cross-sectional study of 277 asymptomatic malaria in children receiving care at paediatric HIV clinics at KBTH and PML was conducted from September to November 2022. Patients who had been on antiretroviral therapy (ART) for at least six months were eligible to participate. Structured questionnaires were used to collect socio-demographic information, malaria prevention behaviors, and ART-related data using in-person interviews. Microscopy and PCR were used to screen for malaria, and GeneXpert was used to determine viral load. To examine the determinants of malaria PCR positivity and virological non-suppression, chi-square tests and logistic regression were performed.

RESULTS

The median age of the participants was 9 years (range: 6-12 years). Males comprised 158 (57%) of the study population. We detected 10 (3.6%) and 21 (7.6%) malaria cases by microscopy and PCR, respectively. Virological non-suppression (VL > 1000 copies/ml) was observed in 82 (29.6%) of the 277 participants. Among the suppressed individuals, 62 (22.4%) exhibited low-level viraemia (VL level 40-1000 copies/ml) and 133 (48%) had undetectable viral load levels. No factors were associated with the presence of malaria PCR positivity carriage. Poor adherence to ART was associated with a five-fold increase in the risk of viral load non-suppression (AOR = 4.89 [CI = 2.00-11.98], p = 0.001).

CONCLUSION

The proportion of children living with HIV with asymptomatic malaria parasitaemia was low. Approximately one-third of the study population had virological non-suppression. The interaction between malaria parasitemia and viral replication may not be the main cause for virological non-suppression in this low transmission area.

摘要

背景

人类免疫缺陷病毒（HIV）和疟疾是撒哈拉以南非洲的两种主要疾病。合并感染会显著影响这两种疾病的临床结果。我们评估了科托努布教学医院（KBTH）和玛丽·路易丝公主医院（PML）感染 HIV 的儿童中疟原虫寄生虫的比例。还确定了这些儿童中无症状疟原虫血症与病毒学未抑制之间的关联。

方法

这是一项在 2022 年 9 月至 11 月期间在 KBTH 和 PML 的儿科 HIV 诊所接受治疗的 277 例无症状疟疾儿童中进行的横断面研究。符合条件的患者必须接受抗逆转录病毒治疗（ART）至少六个月。使用面对面访谈，使用结构化问卷收集社会人口统计学信息、疟疾预防行为和 ART 相关数据。使用显微镜和 PCR 筛查疟疾，使用 GeneXpert 确定病毒载量。为了检查疟疾 PCR 阳性和病毒学未抑制的决定因素，进行了卡方检验和逻辑回归分析。

结果

参与者的中位年龄为 9 岁（范围：6-12 岁）。男性占研究人群的 158 人（57%）。我们通过显微镜和 PCR 分别检测到 10（3.6%）和 21（7.6%）例疟疾。277 名参与者中有 82 名（29.6%）出现病毒学未抑制（VL>1000 拷贝/ml）。在受抑制的个体中，62 名（22.4%）表现出低水平病毒血症（VL 水平为 40-1000 拷贝/ml），133 名（48%）的病毒载量水平不可检测。没有因素与疟疾 PCR 阳性携带有关。ART 依从性差与病毒载量未抑制的风险增加五倍相关（AOR=4.89 [CI=2.00-11.98]，p=0.001）。