Malaria and HIV coinfection in sub-Saharan Africa: prevalence, impact, and treatment strategies

Abstract

Malaria and HIV, two of the world’s most deadly diseases, are widespread, but their distribution overlaps greatly in sub-Saharan Africa. Consequently, malaria and HIV coinfection (MHC) is common in the region. In this paper, pertinent publications on the prevalence, impact, and treatment strategies of MHC obtained by searching major electronic databases (PubMed, PubMed Central, Google Scholar, ScienceDirect, and Scopus) were reviewed, and it was found that the prevalence of MHC in SSA was 0.7%–47.5% overall. Prevalence was 0.7%–47.5% in nonpregnant adults, 1.2%–27.8% in children, and 0.94%–37% in pregnant women. MHC was associated with an increased frequency of clinical parasitemia and severe malaria, increased parasite and viral load, and impaired immunity to malaria in nonpregnant adults, children, and pregnant women, increased in placental malaria and related outcomes in pregnant women, and impaired antimalarial drug efficacy in nonpregnant adults and pregnant women. Although a few cases of adverse events have been reported in coinfected patients receiving antimalarial and antiretroviral drugs concurrently, available data are very limited and have not prompted major revision in treatment guidelines for both diseases. Artemisinin-based combination therapy and cotrimoxazole are currently the recommended drugs for treatment and prevention of malaria in HIV-infected children and adults. However, concurrent administration of cotrimoxazole and sulfadoxine–pyrimethamine in HIV-infected pregnant women is not recommended, because of high risk of sulfonamide toxicity. Further research is needed to enhance our understanding of the impact of malaria on HIV, drug–drug interactions in patients receiving antimalarials and antiretroviral drugs concomitantly, and the development of newer, safer, and more cost-effective drugs and vaccines to prevent malaria in HIV-infected pregnant women.

Plasma levels of interleukin 27 in falciparum malaria is increased independently of co-infection with HIV: potential immune-regulatory role during malaria

“…However, data on IL-27 regulation in clinical malaria is scarce, and to this end, there are no data on IL-27 levels during falciparum malaria in adults. Further, how co-infection with HIV influences IL-27 levels during falciparum malaria is unknown and such knowledge would be of importance in light of a considerable geographic overlap between the two diseases, particularly in sub-Saharan Africa where different interactions between HIV and malaria has been described [12,13].…”

Human Immunodeficiency Virus and Malaria Co-Infection among Adults in the North-Central Zone of Nigeria, in the era of Improved access to Prevention and Control: A Study Protocol

“…It is fundamental to continually initiate and update data on the burden of malaria among PLWHA to prevent new cases of the disease and guide clinical practice in sub-Saharan Africa, especially in Nigeria (WHO, 2015). The majority of the published articles pay little or no attention to the impact of malaria on HIV, rather on the public health effect of HIV on malaria (Kwenti, 2018). This research study aims to provide additional epidemiological data of malaria among HIV seropositive individuals over five years to establish the trend in prevalence while also putting the seasonal variation into consideration.…”

“…Among patients using antimalarial and antiretroviral medicine simultaneously, a couple of notable adverse reactions to the medication have been documented. Being on cotrimoxazole and sulfadoxine-pyrimethamine at the same time is not advocated during pregnancy, due to the likelihood of sulfonamide associated toxicity (Kwenti, 2018). Studies conducted in Nigeria have reported a high prevalence of malaria among PLWHA; however, a limited clinical association between HIV and malaria has been documented in Nigeria (Olorukooba et al, 2016).…”

HIV-malaria co-infection and its determinants among patients attending antiretroviral treatment clinic in Zaria, North-Western Nigeria

“…There are reports that HIV and malaria co-infection may occur in any area that has high prevalence of the two infections (14,15) and that much possibilities of deleterious interaction between the two diseases exist in the co-infected patients (5,6,14). Some complications, such as anaemia, which are common to both HIV and malaria are also likely to be worse with the co-infection (16).…”