Kalyesubula I, Musoke-Mudido P, Marum L, Bagenda D, Aceng E, Ndugwa C, Olness K
Makerere University, Kampala, Uganda.
Pediatr Infect Dis J. 1997 Sep;16(9):876-81. doi: 10.1097/00006454-199709000-00011.
Malaria causes severe morbidity and mortality in many areas of Africa where HIV-1 infection is also prevalent. Immunosuppression is associated with both diseases but most reports do not find significant interactions between them.
A collaborative study of HIV-1 infection in Ugandan women and their infants was established between the Ministry of Health, Makerere University, Kampala, and Case Western Reserve University in 1988. Four hundred fifty-eight infants, including 77 HIV-1-infected, 232 seroreverter and 125 control children born to HIV-1-negative mothers and 24 of indeterminate status were followed closely from birth for 4 years. Data on these infants were reviewed with respect to episodes of general illness and infections, suspected and confirmed episodes of malaria, onset and frequency of malaria, use of chloroquine and occurrence of selected illnesses after episodes of febrile illnesses. Thick and thin blood smears for malaria were obtained from children with fever.
There was no association between occurrence of febrile illnesses and childrens' HIV-1 category. The relative rates of occurrence were 1.0 (95% confidence interval (CI), 0.8 to 1.2) and 1.1 (95% CI 0.9 to 1.4) for the HIV seroreverter and control children compared with the HIV-infected children. Although there was no association (P = 0.83) between HIV-1 status and a smear being taken during a febrile episode, there was an increase in smears positive for malaria parasitemia among seroreverter (risk ratio, 1.5; 95% CI 1.1 to 1.9) and control infants (risk ratio, 1.6; 95% CI 1.2 to 2.2) compared with HIV-1-infected infants. The level of parasitemia was similar in each group. A greater proportion of malaria episodes among the HIV-infected group than among the control groups resulted in hospitalizations (P = 0.001) and blood transfusions (P = 0.02). There was a positive association between time to clinical AIDS and absence of malaria (adjusted for follow-up age) in infected children (P = 0.02). Use of chloroquine was similarly high in each HIV-1 category (80%).
In this group of HIV-infected children there was no significant increase in malarial episodes as compared with their HIV-negative controls. The results suggest a possibility that malaria may offer some protection against HIV-1 progression or that chloroquine used to treat malaria may have a direct effect against the HIV-1 virus.
在非洲许多地区，疟疾导致严重的发病和死亡，而这些地区也是HIV-1感染流行的地方。免疫抑制与这两种疾病都有关联，但大多数报告未发现它们之间有显著的相互作用。
1988年，乌干达卫生部、坎帕拉的马凯雷雷大学和凯斯西储大学开展了一项关于乌干达妇女及其婴儿HIV-1感染的合作研究。458名婴儿，包括77名HIV-1感染婴儿、232名血清转化者和125名HIV-1阴性母亲所生的对照儿童以及24名状态不确定的儿童，从出生起被密切随访4年。对这些婴儿的一般疾病和感染发作、疑似和确诊的疟疾发作、疟疾的发病和频率、氯喹的使用以及发热性疾病发作后选定疾病的发生情况等数据进行了审查。从发热儿童中采集疟疾厚血涂片和薄血涂片。
发热性疾病的发生与儿童的HIV-1类别之间无关联。与HIV感染儿童相比，HIV血清转化者和对照儿童的相对发生率分别为1.0（95%置信区间（CI），0.8至1.2）和1.1（95%CI 0.9至1.4）。虽然HIV-1状态与发热发作期间采集涂片之间无关联（P = 0.83），但与HIV-1感染婴儿相比，血清转化者（风险比，1.5；95%CI 1.1至1.9）和对照婴儿（风险比，1.6；95%CI 1.2至2.2）中疟疾寄生虫血症涂片阳性率有所增加。每组中的寄生虫血症水平相似。HIV感染组中疟疾发作导致住院（P = 0.001）和输血（P = 0.02）的比例高于对照组。在感染儿童中，临床艾滋病发病时间与无疟疾（根据随访年龄调整）之间存在正相关（P = 0.02）。在每个HIV-1类别中氯喹的使用率相似（80%）。
在这组HIV感染儿童中，与HIV阴性对照相比，疟疾发作没有显著增加。结果表明，疟疾可能对HIV-1进展提供某种保护，或者用于治疗疟疾的氯喹可能对HIV-1病毒有直接作用。
