Open Access Highly Accessed Research

Correlates of HIV and malaria co-infection in Southern India

Ajay R Bharti1*, Shanmugam Saravanan2, Vidya Madhavan2, Davey M Smith13, Jabin Sharma2, Pachamuthu Balakrishnan2, Scott L Letendre1 and Nagalingeswaran Kumarasamy2

Author Affiliations

1 University of California San Diego, San Diego, CA, USA

2 YRGCARE Medical Centre, Chennai, India

3 Veterans Affairs Medical Center, San Diego, CA, USA

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Malaria Journal 2012, 11:306  doi:10.1186/1475-2875-11-306

Published: 3 September 2012

Abstract

Background

Malaria and HIV co-infection adversely impact the outcome of both diseases and previous studies have mostly focused on falciparum malaria. Plasmodium vivax contributes to almost half of the malaria cases in India, but the disease burden of HIV and P. vivax co-infection is unclear.

Methods

HIV-infected subjects (n=460) were randomly selected from the 4,611 individuals seen at a Voluntary Counseling and Testing Center in Chennai, India between Jan 2 to Dec 31 2008. Malaria testing was performed on stored plasma samples by nested PCR using both genus-specific and species-specific primers and immunochromatography-based rapid diagnostic test for detecting antibodies against Plasmodium falciparum and P. vivax.

Results

Recent malaria co-infection, defined by the presence of antibodies, was detected in 9.8% (45/460) participants. Plasmodium vivax accounted for majority of the infections (60%) followed by P. falciparum (27%) and mixed infections (13%). Individuals with HIV and malaria co-infection were more likely to be men (p=0.01). Between those with and without malaria, there was no difference in age (p=0.14), CD4+ T-cell counts (p=0.19) or proportion CD4+ T-cell below 200/mL (p=0.51).

Conclusions

Retrospective testing of stored plasma samples for malaria antibodies can facilitate identification of populations with high rates of co-infection, and in this southern India HIV-infected cohort there was a considerable burden of malaria co-infection, predominantly due to P. vivax. However, the rate of P. falciparum infection was more than 6-fold higher among HIV-infected individuals than what would be expected in the general population in the region. Interestingly, individuals co-infected with malaria and HIV were not more likely to be immunosuppressed than individuals with HIV infection alone.

Keywords:
Plasmodium vivax; Plasmodium falciparum; Malaria; HIV; Co-infection; Malaria antibody; Retrospective test