Malaria in HIV/AIDS patients
Combined, malaria and HIV cause more than 2 million deaths each year. Given the considerable geographical overlap between malaria and HIV/AIDS, a substantial number of co-infections occur.
In areas with stable malaria transmission, HIV increases the risk of malaria infection and clinical malaria in adults, especially in those with advanced immunosuppression. In settings with unstable malaria transmission, HIV-infected adults are at increased risk of complicated and severe malaria and death.
Reports also suggest that antimalarial treatment failure may be more common in HIV-infected adults with low CD4-cell counts compared to those not infected with HIV. Additional research is needed to investigate the impact of malaria on the natural history of HIV, potential therapeutic implications, interactions at a cellular and molecular level, and drug interactions between antiretroviral and antimalarial medicines.
Pregnant women at particular risk
Interactions between the 2 infections can have serious consequences, particularly for pregnant women. HIV-infected pregnant women who become infected with malaria are at increased risk of all the adverse outcomes of malaria in pregnancy. Co-infected pregnant women are more likely to have symptomatic malaria infections, anaemia, placental malaria infection, and low birth weight. Epidemiological studies assessing the impact of placental malaria on mother-to-child transmission of HIV have thus far been inconsistent.
Parasite-based diagnosis is crucially important in HIV-infected individuals because of the wide range of infections that can present as fever in HIV patients. Although HIV-related immunosuppression has been shown to be associated with increased treatment failure rates, at present there is insufficient information to modify the general malaria treatment recommendations for patients with HIV/AIDS.
Potential drug-drug interactions
Consideration must be given to possible drug-drug interactions in co-infected patients receiving malaria treatment or preventive therapy and antiretroviral or prophylactic medicines for HIV-infection.
– Treatment or intermittent preventive treatment with sulfadoxine-pyrimethamine should not be given to HIV-infected patients receiving cotrimoxazole (trimethoprim plus sulfamethoxazole) prophylaxis as this increases the risk of sulfonamide-induced adverse drug reactions.
– Treatment in HIV-infected patients on zidovudine or efavirenz should, if possible, avoid amodiaquine-containing ACT regimens, as this increases the risk of neutropenia and hepatotoxicity.