Chandramohan D, Greenwood B M
Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
Int J Epidemiol. 1998 Apr;27(2):296-301. doi: 10.1093/ije/27.2.296.
There is a potential for interaction between malaria and human immunodeficiency virus (HIV) infection. HIV infection might reduce immunity to malaria resulting in more frequent and severe infections; conversely malaria might enhance the progression of HIV infection to AIDS. In this paper we have reviewed some of the studies that have addressed this topic.
Studies identified by a MEDLINE search were systematically reviewed and the measures of association between the two infections were either abstracted or recalculated from the reported data. Inferences drawn from these studies and the biological plausibility of an interaction are discussed.
The prevalence ratio (PR) of peripheral parasitaemia among HIV seropositive (HIVSP) individuals compared to HIV seronegative (HIVSN) individuals ranged from 0.72 to 0.94 in children and from 3.3 to 0.69 in adults. However, only one study showed a statistically significant difference between HIVSP and HIVSN groups (PR 3.3, 95% CI: 2.7-4.2). The rate ratio of non-severe malaria among HIVSP children compared to HIVSN children was 1.4 (95% CI: 0.99-2.0). Data from a trial of chemoprophylaxis during pregnancy suggested that placental malaria may predispose to perinatal transmission of HIV. Studies that have investigated the immune response to P. falciparum among HIVSP subjects have given variable results.
There is no convincing evidence for an interaction between malaria and HIV with the possible exception of an interaction between placental malaria and HIV infection. Several studies, however, had potentials for bias and/or an inadequate sample size. There is a need for carefully designed studies to resolve whether mortality from severe malaria, in particular cerebral malaria, is increased in HIVSP subjects, whether malaria infection of the placenta increases the risk of vertical transmission of HIV, and whether malaria infection increases the progression of HIV infection to AIDS.
疟疾与人类免疫缺陷病毒（HIV）感染之间存在相互作用的可能性。HIV感染可能会降低对疟疾的免疫力，导致感染更加频繁和严重；相反，疟疾可能会加速HIV感染向艾滋病的进展。在本文中，我们回顾了一些针对该主题的研究。
对通过MEDLINE检索确定的研究进行系统回顾，并从报告的数据中提取或重新计算两种感染之间的关联指标。讨论了从这些研究中得出的推论以及相互作用的生物学合理性。
与HIV血清阴性（HIVSN）个体相比，HIV血清阳性（HIVSP）个体外周血寄生虫血症的患病率比值（PR）在儿童中为0.72至0.94，在成人中为3.3至0.69。然而，只有一项研究显示HIVSP组和HIVSN组之间存在统计学上的显著差异（PR 3.3，95%置信区间：2.7 - 4.2）。与HIVSN儿童相比，HIVSP儿童中非重症疟疾的发病率比值为1.4（95%置信区间：0.99 - 2.0）。一项孕期化学预防试验的数据表明，胎盘疟疾可能易导致HIV的围产期传播。对HIVSP受试者中恶性疟原虫免疫反应的研究结果各不相同。
除胎盘疟疾与HIV感染之间可能存在相互作用外，没有令人信服的证据表明疟疾与HIV之间存在相互作用。然而，几项研究存在偏倚可能性和/或样本量不足的问题。需要精心设计的研究来确定HIVSP个体中严重疟疾（特别是脑型疟疾）的死亡率是否增加、胎盘疟疾感染是否会增加HIV垂直传播的风险以及疟疾感染是否会加速HIV感染向艾滋病的进展。
