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Updated: Jul 3, 2026
An In Vitro Model for Measuring Immune Responses to Malaria in the Context of HIV Co-infection
Published on: October 6, 2015
Imported malaria in HIV-infected patients enrolled in the ANRS CO4 FHDH study
Christian Mouala1, Sandrine Houzé, Marguerite Guiguet
1INSERM, U720, Paris, F-75013 France. cmouala@ccde.chups.jussieu.fr
Background:
To describe episodes of imported malaria in human immunodeficiency virus type 1-infected patients and to study the risk factors for severe Plasmodium falciparum malaria.
Methods:
Patients enrolled in the French Hospital Database on HIV who were diagnosed with a first episode of malaria between 1996 and 2003 were included. The severity of P. falciparum imported malaria was graded with World Health Organization criteria. Geographic areas were classified according to P. falciparum chemoresistance. Risk factors for severe malaria were identified with logistic regression.
Results:
We studied 190 patients infected by P. falciparum in 178 cases. All but four of the patients were infected in sub-Saharan Africa, and half were returning from a country with a high P. falciparum chloroquine resistance. Their median age was 37.5 years, and 57% came from a country endemic with malaria. The median CD4 cell count was 299/mm, and the median plasma human immunodeficiency virus type 1 RNA load was 4.5 log10 copies/mL. Sixty-five (36.5%) episodes of P. falciparum malaria were severe. Severe imported malaria was associated with CD4 cells/mm <350 (odds ratio = 2.58; 95% confidence interval: 1.19 to 5.57). The risk of severe malaria was lower in patients returning from a country with a high prevalence of chemoresistance (odds ratio = 0.50; 95% confidence interval: 0.25 to 0.99).
Conclusions:
Severe imported malaria in human immunodeficiency virus type 1-infected patients is associated with decreased CD4 cell count. The risk seems lower when P. falciparum infection was acquired in areas of high prevalence of chemoresistance.
Insights
Imported malaria in patients with human immunodeficiency virus (HIV) is linked to lower CD4 cell counts. However, acquiring Plasmodium falciparum malaria in areas with high drug resistance may reduce severe outcomes.
Area of Science:
- Infectious Diseases
- Immunology
- Tropical Medicine
Background:
- Imported malaria poses a risk to HIV-1 infected individuals.
- Understanding risk factors for severe Plasmodium falciparum malaria in this population is crucial.
Purpose of the Study:
- To describe imported malaria cases in HIV-1 patients.
- To identify risk factors associated with severe Plasmodium falciparum malaria.
Main Methods:
- Analysis of malaria cases in HIV-1 patients from the French Hospital Database on HIV (1996-2003).
- Classification of malaria severity using WHO criteria.
- Assessment of Plasmodium falciparum chemoresistance prevalence by geographic area.
- Logistic regression to identify severe malaria risk factors.
Main Results:
- 190 malaria episodes studied, predominantly Plasmodium falciparum (178 cases), mostly acquired in sub-Saharan Africa.
- 36.5% of P. falciparum malaria cases were severe.
- Severe malaria associated with CD4 cell count <350/mm³ (OR=2.58).
- Lower risk of severe malaria observed in patients returning from high chemoresistance areas (OR=0.50).
Conclusions:
- Decreased CD4 cell count is a significant risk factor for severe imported malaria in HIV-1 infected patients.
- Acquisition of P. falciparum malaria in regions with high drug resistance prevalence may be associated with a reduced risk of severity.
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