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Malaria and HIV co-infection: available evidence, gaps and possible interventions.

OBJECTIVES
To review the evidence of association between malaria and HIV/AIDS co-infection for purposes of developing strategies for malaria control.


DESIGN
Desktop review of literature.


SETTING
Harare, Zimbabwe.


MAIN OUTCOME MEASURES
Response to treatment, development of severe malaria, malarial immunological response in HIV/AIDS positive people and incidence of malaria in HIV/AIDS positive individuals.


RESULTS
HIV-1 infection increases the incidence of Plasmodium falciparum parasitaemia and is associated with the development of severe malaria, commonly anaemia, cerebral malaria and high parasite density (OR = 2.56; 95% CI = 1.53 to 4.29; p < 0.001). The efficacy of chloroquine and sulphadoxine-pyrimethamine in reducing placental malaria in HIV-1 positive pregnant women was impaired compared to HIV-1 negative pregnant women. However, the situation in non-gravid HIV-1 positive people as regards efficacy of chloroquine and sulphadoxine-pyrimethamine prophylaxis is not known. Also not known is the relationship between malaria parasitaemia without symptoms and HIV-1 infection, the results of which may provide useful information regarding malaria control and prevention in HIV-1 positive people.


CONCLUSIONS
HIV-1 positive people staying in malaria endemic areas are at risk of developing severe malaria. Malaria prevention using insecticide-treated bednets and indoor residual house spraying may be the best available options for these people. Chloroquine and sulphadoxine-pyrimethamine prophylaxis require further studies to verify their efficacy, in the presence of HIV-1/AIDS infection.