Effect of HIV-1 infection on malaria treatment outcome in Ugandan patients

P Byakika-Kibwika, E Ddumba, M Kamya

Abstract

Background: Malaria and HIV-1 infection cause significant morbidity and mortality in sub-Saharan Africa. HIV-1 increases risk for malaria with the risk increasing as immunity declines.The effect of HIV-1 infection on antimalarial treatment outcome is still inconclusive.

Objective: To compare antimalarial treatment outcome among HIV-1 positive and negative patients with acute uncomplicated falciparum malaria treated with chloroquine plus sulfadoxine-pyrimethamine (CQ+SP).

Methods: Ninety eight HIV-1 positive patients aged 18 months or older with acute uncomplicated falciparum malaria were treated with CQ+SP and followed for 28 days to monitor outcome.Treatment outcome of HIV-1 positive patients was compared to that of 193 HIV-1 negative historical controls.The primary study outcome for both groups was treatment failure.

Results: HIV-1 positive patients older than 5 years of age were less likely to have treatment failure compared to HIV-1 negative patients in the same age group (RR 0.59 95% CI 0.4- 0.8, p α 0.001) and HIV-1 positive patients on routine cotrimoxazole prophylaxis were less likely to have treatment failure following CQ+SP treatment compared to HIV negative patients (RR 0.6 95% CI 0.43-0.92, p = 0.006).There was no difference in treatment outcome according to HIV-1 status for children younger than 5 years of age.

Conclusions: Adherence to cotrimoxazole prophylaxis should be reinforced in HIV positive patients and it should be reassessed if these patients present with acute episodes of malaria.

Keywords: malaria, HIV, Uganda, antimalarial treatment response