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Epidemiology of malaria in HIV infected Ugandan patients on antiretroviral therapy (ART) - a prospective cohort study
Presented by Ronnie Kasirye (Uganda).
R. Kasirye1, J. Levin1, P. Munderi1, L. Okell2, S. Walker3, A. Mugisha1, H. Grosskurth1,2
1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda, 2London School Hygiene and Tropical Medicine, London, United Kingdom, 3MRC Clinical Trials Unit, London, United Kingdom
Background: There have been several reports on the association between malaria and HIV infection. However, the effect on this association of treating HIV with ART has not been widely reported. We assessed the incidence of malaria and its potential risk factors in a cohort of adults on ART.
Methods: 1020 adults enrolled into the DART study, in a high malaria transmission area, were followed up over a period of 4 years during which patients were clinically reviewed at monthly intervals and whenever ill. All illnesses with fever were investigated for malaria. For the purposes of this analysis malaria is defined as a fever reported by the patient plus P falciparum parasitaemia on peripheral blood film. Crude and adjusted rate ratios for Malaria were determined.
Results:
| Year of ART | year 1 | year 2 | year 3 | >3 years | | Incidence of Malaria per 1000 person years
[95% CI] | 591 [544-641] | 476[434-522] | 259[228-294] | 153[128-183] |
In unadjusted analysis, younger age (p = 0.0003), lower CD4 count at initiation of ART (p=0.03) and low level of education (p< 0.0001) were significantly associated with occurrence of malaria.
Conclusions: Malaria incidence declines with time on ART. Factors associated with malaria in this study population are education, age and baseline CD4.
Implications: In countries where both diseases contribute significantly to disease burden, the indirect effect of ART could help reduce this burden. During ART, additional malaria prevention interventions should be targeted at the more vulnerable patients with advanced immune suppression.
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