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Longitudinal and Cross-sectional Analyses of Asymptomatic HIV-1/Malaria Co-infection in Kisumu County, Kenya

Janet OyiekoKombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya;

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Nathanial K. CopelandTripler Army Medical Center, Honolulu, Hawaii;

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Solomon OtienoKombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya;

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Carolyne KifudeKombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya;

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Stephen OchollaKombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya;

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Jack HutterKombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya;

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Hunter SmithKombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya;

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Ashleigh RoberdsUniformed Services University of the Health Sciences, Bethesda, Maryland;

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Shirley LuckhartDepartment of Entomology, Plant Pathology and Nematology, University of Idaho, Moscow, Idaho;
Department of Biological Sciences, University of Idaho, Moscow, Idaho

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V. Ann StewartUniformed Services University of the Health Sciences, Bethesda, Maryland;

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ABSTRACT.

Individuals infected with HIV-1 experience more frequent and more severe episodes of malaria and are likely to harbor asymptomatic parasitemia, thus potentially making them more efficient reservoirs of malaria. Two studies (cross-sectional and longitudinal) were designed in sequence between 2015–2018 and 2018–2020, respectively, to test the hypothesis that HIV-1 infected individuals have higher prevalence of asymptomatic parasitemia and gametocytemia than the HIV-1 negatives. This article describes the overall design of the two studies, encompassing data for the longitudinal study and additional data to the previously published baseline data for the cross-sectional study. In the cross-sectional study, HIV-1 positive participants were significantly older, more likely to be male, and more likely to have parasitemia relative to HIV-1 negatives (P < 0.01). In the longitudinal study, 300 participants were followed for 6 months. Of these, 102 were HIV-1 negative, 106 were newly diagnosed HIV-1 positive, and 92 were HIV-1 positive and on antiretroviral therapy, including antifolates, at enrollment. Overall parasitemia positivity at enrollment was 17.3% (52/300). Of these, 44% (23/52) were HIV-1 negative, 52% (27/52) were newly diagnosed HIV-1 positives, and only 4% (2/52) were HIV-1 positive and on treatment. Parasitemia for those on stable antiretroviral therapy was significantly lower (hazard ratio: 0.51, P < 0.001), compared with the HIV-1-negatives. On follow-up, there was a significant decline in parasitemia prevalence (hazard ratio: 0.74, P < 0.001) among the HIV patients newly initiated on antiretroviral therapy including trimethoprim-sulfamethoxasole. These data highlight the impact of HIV-1 and HIV treatment on asymptomatic parasitemia over time.

Author Notes

Address correspondence to Janet Oyieko, Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, P.O. Box 54-40100, Kisumu, Kenya. E-mail: janet.oyieko@usamru-k.org

Financial support: This work was supported by NIH National Institute of Allergy and Infectious Diseases R01 AI104423 (to V. A. S. and S. L.).

Disclaimer: The contents, views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policy or position of Uniformed Services University of the Health Sciences. Mention of trade names, commercial products and organizations does not imply endorsement by the U.S. Government. Material has been reviewed by the Walter Reed Army Institute of Research. There is no objection to its presentation and/or publication. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting true views of the Department of the Army or the Department of Defense. The investigators have adhered to the policies for protection of human subjects as prescribed in AR 70-25.

Authors addresses: Janet Oyieko, Carolyne Kifude, Solomon Otieno, Stephen Ocholla, Jack Hutter, and Hunter Smith, Kombewa Clinical Research Center, Kenya Medical Research Institute-US Army Medical Research Directorate-Africa, Kisumu, Kenya, E-mails: janet.oyieko@usamru-k.org, carolyne.kifude@usamru-k.org, Solomon.otieno @usamru-k.org, stephen.ocholla@usamru-k.org, jack.hutter@usamru-k.org, and hunterjsmith11@gmail.com. Nathanial K. Copeland, Tripler Army Medical Center, Honolulu, HI, E-mail: nathanial.k.copeland.mil@mail.mil. V. Ann Stewart and Ashleigh Roberds, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, E-mails: annstew@me.com and ashleigh.roberds@usuhs.edu. Shirley Luckhart, Department of Entomology, Plant Pathology and Nematology, University of Idaho, Moscow, ID, and Department of Biological Sciences, University of Idaho, Moscow, ID, E-mail: sluckhart@uidaho.edu.

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