Human immunodeficiency virus type 1 infection in patients with severe falciparum malaria in urban India.
AA Khasnis, DR Karnad
Department of Medicine, K. E. M. Hospital, Parel, Mumbai - 400012, India. , India
BACKGROUND: CD4+ T cells restrict parasitaemia during the first attack of falciparum malaria; humoral immunity, develops weeks later and protects against reinfection. HIV infection may affect severity of falciparum malaria and development of protective immunity. AIMS: To study the prevalence of HIV infection in Indian patients with severe falciparum malaria and its effect on severity of illness and recurrences of and mortality related to malarial infection. PATIENTS: Consecutive patients with severe falciparum malaria and voluntary blood donors. SETTING AND DESIGN: Prospective cohort study in a university hospital in Mumbai. RESULTS: Five (11.6%) of 43 patients and 521 (1.8%) of 28749 blood donors had HIV infection (OR 7.1, 95% CI = 2.8 to 18.2, p=0.001). Clinical features, APACHE II score, number of organs affected, parasite index and mortality in patients with and without HIV infection were comparable. CD4+ counts were < 500 cells/ microl in 2 patients and normal in 3. Opportunistic infections including pulmonary tuberculosis in one patient (CD4+ counts > 500 cells/ microl), and oral candidiasis in two (CD4+ counts 275 and 250 cells/ microl) were noted. One patient developed fatal Pneumocystis carinii pneumonia two weeks after recovering from malaria. P. falciparum infection recurred in 2 of the 4 HIV infected survivors and in none of 31 survivors without HIV infection (RR 38.8, 95% CI 2.2 to 671, p=0.01). CONCLUSIONS: HIV infection is associated with increased risk of severe malaria even with normal CD4+ counts; severity of disease and mortality are not increased. However, prior HIV infection impairs protective immune response to Plasmodium falciparum in residents of hypoendemic areas.
A A Khasnis
Department of Medicine, K. E. M. Hospital, Parel, Mumbai - 400012, India.
|How to cite this article:|
Khasnis A A, Karnad D R. Human immunodeficiency virus type 1 infection in patients with severe falciparum malaria in urban India. J Postgrad Med 2003;49:114-7
|How to cite this URL:|
Khasnis A A, Karnad D R. Human immunodeficiency virus type 1 infection in patients with severe falciparum malaria in urban India. J Postgrad Med [serial online] 2003 [cited 2021 Oct 18 ];49:114-7
Available from: https://www.jpgmonline.com/article.asp?issn=0022-3859;year=2003;volume=49;issue=2;spage=114;epage=7;aulast=Khasnis;type=0