Examining the interaction between human immunodeficiency virus and malaria infections using data from prospective cohort studies in Uganda

Malaria and HIV are critical health problems facing sub-Saharan Africa. Unfortunately, it is unknown whether HIV infection increases the incidence of malaria in African children. There are also concerns that widespread cotrimoxazole prophylaxis in HIV-infected persons, would select for anti-folate-resistant malaria, impairing the efficacy of sulfadoxine-pyrimethamine and accelerating its failure.; I assessed (i) The effect of HIV-infection on morbidity and mortality in children with severe malarial anemia, (ii) The effect of HIV-infection on transfusion-associated transmission of malaria pathogens, (iii) The effect of cotrimoxazole prophylaxis used by HIV-infected persons on the selection of sulfadoxine-pyrimethamine-resistant malaria parasites among both HIV-infected and HIV-uninfected family members, (iv) the effect of sulfadoxine-pyrimethamine on malaria treatment outcomes in HIV-infected persons by cotrimoxazole use.; These were secondary data analyses of 1186 hospital patients requiring blood transfusion and 2567 HIV-infected clients of The AIDS Support Organization and their household members participating in two prospective cohort studies in Uganda between December 2000 and April 2002.; HIV-infected children <5 years of age with severe malarial anemia had similar rates of new malaria infections, but higher incidence of re-hospitalization, all-cause mortality and malaria-related mortality than HIV-uninfected children; HIV-infection seems to modify the risk of malaria infection through blood transfusion. HIV-infected participants who received at least one malaria parasite-contaminated unit of blood were 65% more likely to develop subsequent clinical malaria infection than those receiving malaria parasite free blood unit(s); There was no association for HIV-uninfected recipients. Cotrimoxazole prophylaxis was not associated with sulfadoxine-pyrimethamine-resistant malaria in HIV-infected taking cotrimoxazole or HIV-uninfected household members not taking it. Cotrimoxazole prophylaxis had no effect on malaria treatment outcomes in HIV-infected persons treated with sulfadoxine-pyrimethamine.; These results suggests that sulfadoxine-pyrimethamine efficacy for treating or preventing malaria is not impaired by cotrimoxazole prophylaxis. Therefore, the increasing prevalence of sulfadoxine-pyrimethamine-resistant genotypes is due to factors other than cotrimoxazole use. To reduce the lethal consequences of dual infection with HIV and malaria, prevention and treatment programs of the two diseases must be reinforcing.