Diagnosis, clinical presentation, and in-hospital mortality of severe malaria in HIV-coinfected children and adults in Mozambique.

Abstract

BACKGROUND:

Severe falciparum malaria with human immunodeficiency virus (HIV) coinfection is common in settings with a high prevalence of both diseases, but there is little information on whether HIV affects the clinical presentation and outcome of severe malaria.

METHODS:

HIV status was assessed prospectively in hospitalized parasitemic adults and children with severe malaria in Beira, Mozambique, as part of a clinical trial comparing parenteral artesunate versus quinine (ISRCTN50258054). Clinical signs, comorbidity, complications, and disease outcome were compared according to HIV status.

RESULTS:

HIV-1 seroprevalence was 11% (74/655) in children under 15 years and 72% (49/68) in adults with severe malaria. Children with HIV coinfection presented with more severe acidosis, anemia, and respiratory distress, and higher peripheral blood parasitemia and plasma Plasmodium falciparum histidine-rich protein-2 (PfHRP2). During hospitalization, deterioration in coma score, convulsions, respiratory distress, and pneumonia were more common in HIV-coinfected children, and mortality was 26% (19/74) versus 9% (53/581) in uninfected children (P < .001). In an age- and antimalarial treatment-adjusted logistic regression model, significant, independent predictors for death were renal impairment, acidosis, parasitemia, and plasma PfHRP2 concentration.

CONCLUSIONS:

Severe malaria in HIV-coinfected patients presents with higher parasite burden, more complications, and comorbidity, and carries a higher case fatality rate. Early identification of HIV coinfection is important for the clinical management of severe malaria.

• Authors: Ilse C E Hendriksen, Josefo Ferro, Pablo Montoya, Kajal D Chhaganlal, Amir Seni, Ermelinda Gomes, Kamolrat Silamut, Sue J Lee, Marcelino Lucas, Kesinee Chotivanich, Caterina I Fanello, Nicholas P J Day, Nicholas J White, Lorenz von Seidlein, Arjen M Dondorp
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 55 Issue 8 Pg. 1144-53 (Oct 2012) ISSN: 1537-6591 [Electronic] United States
• PMID: 22752514 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, Protozoan
• HRP-2 antigen, Plasmodium falciparum
• Protozoan Proteins

Topics

• Adolescent
• Adult
• Antigens, Protozoan (blood)
• Chi-Square Distribution
• Child
• Child, Preschool
• Coinfection (epidemiology, mortality)
• Female
• HIV Infections (epidemiology, mortality, parasitology)
• Humans
• Logistic Models
• Malaria, Falciparum (diagnosis, epidemiology, mortality, virology)
• Male
• Mozambique (epidemiology)
• Parasitemia (epidemiology, mortality, parasitology, virology)
• Prospective Studies
• Protozoan Proteins (blood)