Volume 82, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



We examined the cross-sectional relationships between malaria parasitemia and CD4 T cell count and viral load among human immunodeficiency virus (HIV)-infected pregnant women. We then followed women to investigate whether or not baseline parasitemia predicted CD4 T cell counts or viral loads > 90 days post-baseline or predicted time to HIV disease stage 3 or 4 or acquired immune deficiency syndrome (AIDS)-related death (ARD). Parasitemia level was nonlinearly associated with viral load at baseline and among measurements taken > 90 days post-baseline; women with low baseline parasitemia, versus none, had higher viral loads at both time points. Any baseline parasitemia predicted an increased rate of ARD among women with baseline CD4 T cell counts ≥ 500 cells/µL (ratio rate [RR] = 2.6; 95% confidence interval [CI] = 1.1–6.0; test for heterogeneity = 0.05). Further study is warranted to determine whether or not parasitemia is especially detrimental to individuals with lower levels of immunosuppression or chronic low parasitemia.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, UNAIDS, 2008. Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector, Progress Report. Available at: http://www.unaidsrstesa.org/userfiles/file/towards_universal_access_report_2008%5B1%5D(1).pdf. Accessed March 7, 2009. [Google Scholar]
  2. World Health Organization, 2008. Antiretroviral Therapy for HIV Infection in Adults and Adolescents: Recommendations for a Public Health Approach, 2006 Revision. Available at: http://www.who.int/hiv/pub/guidelines/artadultguidelines.pdf. Accessed March 7, 2009. [Google Scholar]
  3. Holmes CB, Losina E, Walensky RP, Yazdanpanah Y, Freedberg KA, , 2003. Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa. Clin Infect Dis 36: 652662.[Crossref] [Google Scholar]
  4. French N, Nakiyingi J, Lugada E, Watera C, Whitworth JA, Gilks CF, , 2001. Increasing rates of malarial fever with deteriorating immune status in HIV-1-infected Ugandan adults. AIDS 15:899906.[Crossref] [Google Scholar]
  5. Ladner J, Leroy V, Simonon A, Karita E, Bogaerts J, De Clercq A, Van De Perre P, Dabis F, , 2002. HIV infection, malaria, and pregnancy: a prospective cohort study in Kigali, Rwanda. Am J Trop Med Hyg 66: 5660. [Google Scholar]
  6. Laufer MK, van Oosterhout JJ, Thesing PC, Thumba F, Zijlstra EE, Graham SM, Taylor TE, Plowe CV, , 2006. Impact of HIV-associated immunosuppression on malaria infection and disease in Malawi. J Infect Dis 193: 872878.[Crossref] [Google Scholar]
  7. Patnaik P, Jere CS, Miller WC, Hoffman IF, Wirima J, Pendame R, Meshnick SR, Taylor TE, Molyneux ME, Kublin JG, , 2005. Effects of HIV-1 serostatus, HIV-1 RNA concentration, and CD4 cell count on the incidence of malaria infection in a cohort of adults in rural Malawi. J Infect Dis 192: 984991.[Crossref] [Google Scholar]
  8. Kamya MR, Gasasira AF, Yeka A, Bakyaita N, Nsobya SL, Francis D, Rosenthal PJ, Dorsey G, Havlir D, , 2006. Effect of HIV-1 infection on antimalarial treatment outcomes in Uganda: a population-based study. J Infect Dis 193: 915.[Crossref] [Google Scholar]
  9. Whitworth J, Morgan D, Quigley M, Smith A, Mayanja B, Eotu H, Omoding N, Okongo M, Malamba S, Ojwiya A, , 2000. Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study. Lancet 356: 10511056.[Crossref] [Google Scholar]
  10. Froebel K, Howard W, Schafer JR, Howie F, Whitworth J, Kaleebu P, Brown AL, Riley E, , 2004. Activation by malaria antigens renders mononuclear cells susceptible to HIV infection and re-activates replication of endogenous HIV in cells from HIV-infected adults. Parasite Immunol 26: 213217.[Crossref] [Google Scholar]
  11. Pisell TL, Hoffman IF, Jere CS, Ballard SB, Molyneux ME, Butera ST, Lawn SD, , 2002. Immune activation and induction of HIV-1 replication within CD14 macrophages during acute Plasmodium falciparum malaria coinfection. AIDS 16: 15031509.[Crossref] [Google Scholar]
  12. Xiao L, Owen SM, Rudolph DL, Lal RB, Lal AA, , 1998. Plasmodium falciparum antigen-induced human immunodeficiency virus type 1 replication is mediated through induction of tumor necrosis factor-alpha. J Infect Dis 177: 437445.[Crossref] [Google Scholar]
  13. O'Brien WA, Hartigan PM, Martin D, Esinhart J, Hill A, Benoit S, Rubin M, Simberkoff MS, Hamilton JD, , 1996. Changes in plasma HIV-1 RNA and CD4+ lymphocyte counts and the risk of progression to AIDS. Veterans Affairs Cooperative Study Group on AIDS. N Engl J Med 334: 426431.[Crossref] [Google Scholar]
  14. Sterling TR, Vlahov D, Astemborski J, Hoover DR, Margolick JB, Quinn TC, , 2001. Initial plasma HIV-1 RNA levels and progression to AIDS in women and men. N Engl J Med 344: 720725.[Crossref] [Google Scholar]
  15. Kapiga SH, Bang H, Spiegelman D, Msamanga GI, Coley J, Hunter DJ, Fawzi WW, , 2002. Correlates of plasma HIV-1 RNA viral load among HIV-1-seropositive women in Dar es Salaam, Tanzania. J Acquir Immune Defic Syndr 30: 316323.[Crossref] [Google Scholar]
  16. Hoffman IF, Jere CS, Taylor TE, Munthali P, Dyer JR, Wirima JJ, Rogerson SJ, Kumwenda N, Eron JJ, Fiscus SA, Chakraborty H, Taha TE, Cohen MS, Molyneux ME, , 1999. The effect of Plasmodium falciparum malaria on HIV-1 RNA blood plasma concentration.AIDS 13: 487494.[Crossref] [Google Scholar]
  17. Kublin JG, Patnaik P, Jere CS, Miller WC, Hoffman IF, Chimbiya N, Pendame R, Taylor TE, Molyneux ME, , 2005. Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi: a prospective cohort study. Lancet 365: 233240. [Google Scholar]
  18. Quigley MA, Hewitt K, Mayanja B, Morgan D, Eotu H, Ojwiya A, Whitworth JA, , 2005. The effect of malaria on mortality in a cohort of HIV-infected Ugandan adults. Trop Med Int Health 10: 894900.[Crossref] [Google Scholar]
  19. Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, Hunter DJ, , 1999. Rationale and design of the Tanzania vitamin and HIV infection trial. Control Clin Trials 20: 7590.[Crossref] [Google Scholar]
  20. Fawzi WW, Msamanga GI, Spiegelman D, Wei R, Kapiga S, Villamor E, Mwakagile D, Mugusi F, Hertzmark E, Essex M, Hunter DJ, , 2004. A randomized trial of multivitamin supplements and HIV disease progression and mortality. N Engl J Med 351: 2332.[Crossref] [Google Scholar]
  21. Tanzania Ministry of Health, 2009. National Medium Term Strategic Plan 2002–2007. Available at: http://www.rollbackmalaria.org/countryaction/nsp/tanzania.pdf. Accessed March 7, 2009. [Google Scholar]
  22. National Bureau of Statistics (Tanzania) and Macro International Inc., 2000. Tanzania Reproductive and Child Health Survey 1999. Calverton, MD: National Bureau of Statistics and Macro International Inc. [Google Scholar]
  23. Trape JF, , 1985. Rapid evaluation of malaria parasite density and standardization of thick smear examination for epidemiological investigations. Trans R Soc Trop Med Hyg 79: 181184.[Crossref] [Google Scholar]
  24. Mulligan JA, Mandike R, Palmer N, Williams H, Abdulla S, Bloland P, Mills A, , 2006. The costs of changing national policy: lessons from malaria treatment policy guidelines in Tanzania. Trop Med Int Health 11: 452461.[Crossref] [Google Scholar]
  25. 1990. Interim proposal for a WHO staging system for HIV infection and disease. Wkly Epidemiol Rec 65: 221224. [Google Scholar]
  26. Govindarajulu US, Spiegelman D, Thurston SW, Ganguli B, Eisen EA, , 2007. Comparing smoothing techniques in Cox models for exposure-response relationships. Stat Med 26: 37353752.[Crossref] [Google Scholar]
  27. Cox DR, , 1972. Regression models and life-tables. J R Stat Soc B 34: 187220. [Google Scholar]
  28. Cochran WG, , 1950. The comparison of percentages in matched samples. Biometrika 37: 256266.[Crossref] [Google Scholar]
  29. Toossi Z, Mayanja-Kizza H, Hirsch CS, Edmonds KL, Spahlinger T, Hom DL, Aung H, Mugyenyi P, Ellner JJ, Whalen CW, , 2001. Impact of tuberculosis (TB) on HIV-1 activity in dually infected patients. Clin Exp Immunol 123: 233238.[Crossref] [Google Scholar]
  30. Whalen CC, Nsubuga P, Okwera A, Johnson JL, Hom DL, Michael NL, Mugerwa RD, Ellner JJ, , 2000. Impact of pulmonary tuberculosis on survival of HIV-infected adults: a prospective epidemiologic study in Uganda. AIDS 14: 12191228.[Crossref] [Google Scholar]
  31. Bodker R, Msangeni HA, Kisinza W, Lindsay SW, , 2006. Relationship between the intensity of exposure to malaria parasites and infection in the Usambara Mountains, Tanzania. Am J Trop Med Hyg 74: 716723. [Google Scholar]
  32. Ladeia-Andrade S, Ferreira MU, de Carvalho ME, Curado I, Coura JR, , 2009. Age-dependent acquisition of protective immunity to malaria in riverine populations of the Amazon Basin of Brazil. Am J Trop Med Hyg 80: 452459. [Google Scholar]
  33. Trape JF, Rogier C, Konate L, Diagne N, Bouganali H, Canque B, Legros F, Badji A, Ndiaye G, Ndiaye P, Brahimi K, Faye O, Druilhe P, Pereira Da Silva L, , 1994. The Dielmo project: a longitudinal study of natural malaria infection and the mechanisms of protective immunity in a community living in a holoendemic area of Senegal. Am J Trop Med Hyg 51: 123137. [Google Scholar]
  34. Mayor A, Aponte JJ, Fogg C, Saute F, Greenwood B, Dgedge M, Menendez C, Alonso PL, , 2007. The epidemiology of malaria in adults in a rural area of southern Mozambique. Malar J 6: 3. [Crossref] [Google Scholar]
  35. Van Geertruyden JP, Mulenga M, Kasongo W, Polman K, Colebunders R, Kestens L, D'Alessandro U, , 2006. CD4 T-cell count and HIV-1 infection in adults with uncomplicated malaria. J Acquir Immune Defic Syndr 43: 363367.[Crossref] [Google Scholar]
  36. World Health Organization, 2009. Malaria and HIV Interactions and Their Implications for Public Health Policy. Available at: http://www.who.int/malaria/malaria_HIV/MalariaHIVinteractions_report.pdf. Accessed March 21, 2009. [Google Scholar]

Data & Media loading...

  • Received : 19 Aug 2009
  • Accepted : 07 Jan 2010
  • Published online : 05 Apr 2010

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error