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Video:HIV and malaria coinfection

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HIV and malaria coinfection (Tutorial)
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Description

HIV and malaria coinfection is a serious health issue, especially in regions where both diseases are widespread(sub-sahara Africa). HIV weakens the immune system, making individuals more vulnerable to severe malaria, while malaria can increase HIV viral load, accelerating disease progression and transmission. This interaction is harmful in pregnant women and children, leading to higher risks of anemia, low birth weight, and infant mortality. Coinfection complicates treatment and therefore a good prognosis.Studies show that the prevalence of coinfection ranges from 1 (point) 2 to 27 (point) 8 percent in children, and 0 (point) 9 to 37 percent in pregnant women.[1][2]

Presentation

We find specific symptoms in coinfected individuals include more intense fever episodes. While malaria usually causes cyclical fevers, HIV-positive individuals may experience these fevers as more prolonged or severe;also we may see the following: profound anemia, jaundice , hepatosplenomegaly, nausea and in pregnant women(significant risks for adverse birth outcomes).[3][4][5]

Cause

Malaria- is a disease caused by Plasmodium parasites, transmitted through bites from infected female Anopheles mosquitoes.[6]HIV- is a virus that attacks the immune system, specifically the CD4 cells, which help fight off infections.Untreated, HIV can lead to AIDS (Acquired Immunodeficiency Syndrome).[7]

Mechanism

In terms of the co-infection we find that malaria triggers a widespread activation of immune system, leading to a increase of pro-inflammatory cytokines. This immune disruption provides a good environment for HIV to replicate faster, temporarily increasing the viral load and accelerating the destruction of important immune cells. In turn HIV's progressive weakening of immune system(depletion of CD4+ T cells) cripples the bodys ability to make an effective defense against malaria. The impaired immunity leads to a higher frequency and greater severity of malaria episodes, higher parasite densities.This cycle of mutual exacerbation results in faster disease progression for HIV and more severe clinical outcomes for malaria.[8][9][10]

Diagnosis

In terms of evaluating HIV and malaria coinfection involves recognizing overlapping symptoms(fever and fatigue), then confirming each disease through specific tests: for malaria- the use of rapid diagnostic tests and microscopy.For HIV the use of ELISA or PCR.[11]

Prevention

In terms of preventive measures we find the use of insecticide-treated nets and indoor residual spraying is associated with a lower likelihood of HIV-malaria co-infection.[12]

Treatment

In terms of management strategy involves using artemisinin-based combination therapies for malaria and antiretroviral therapy for HIV, while considering how the drugs affect each other. For example certain HIV drugs like efavirenz can reduce the effectiveness of some ACT, necessitating a longer course of antimalarial treatment.[13][11]

Adverse reaction

Coinfection of malaria and HIV presents a treatment problem due to complex drug-drug interactions between antimalarial and antiretroviral drugs. These interactions can lead to adverse reactions, because both drug classes often share the same metabolic pathways in liver, particularly the cytochrome P450 enzyme system. This can cause increased toxicity, such as a risk of hematological issues like anemia, hepatotoxicity, and heart rhythm abnormalities from drugs like quinine and ritonavir. Furthermore interactions can lead to poor drug levels, causing treatment failure and causing drug resistance, particularly with the use of antiretroviral efavirenz, which can reduce the efficacy of antimalarial drugs like artemether-lumefantrine.[14][15][16][17]

Epidemiology

As to the countries with the most cases of HIV and malaria co-infection are located in sub-Saharan Africa. This region is considered the epicenter for both diseases, with a significant geographical and social overlap. Some of the most severely affected include:[18][19] Zambia, Zimbabwe, Mozambique, Malawi and Central African Republic.

History

Historically, early observations in the 1990s revealed that people with HIV were more prone to severe malaria, and those with malaria faced greater risks from HIV. This sparked studies investigating the biological and epidemiological interactions between the two diseases. In 2007, researchers at Arizona State University created a mathematical model to examine the impact of HIV and malaria co-infections on disease dynamics in sub-Saharan Africa.[20][21]

Research

A 2024 study published in The Lancet suggests that adding the antimalarial drug dihydroartemisinin-piperaquine to the daily dose of cotrimoxazole,a prophylactic drug for opportunistic infections in HIV patients, can significantly reduce the risk of malaria in pregnant women with HIV.[22]

References

  1. ↑ Slutsker, Laurence; Marston, Barbara J. (February 2007). "HIV and malaria: interactions and implications". Current Opinion in Infectious Diseases. 20 (1): 3–10. doi:10.1097/QCO.0b013e328012c5cd. ISSN 0951-7375. PMID 17197875.
  2. ↑ Kwenti, Tebit Emmanuel (July 2018). "Malaria and HIV coinfection in sub-Saharan Africa: prevalence, impact, and treatment strategies". Research and Reports in Tropical Medicine. 9: 123–136. doi:10.2147/RRTM.S154501. PMC 6067790. PMID 30100779.
  3. ↑ Hochman, Sarah; Kim, Kami (2009). "The Impact of HIV and Malaria Coinfection: What Is Known and Suggested Venues for Further Study". Interdisciplinary Perspectives on Infectious Diseases. 2009: 617954. doi:10.1155/2009/617954. ISSN 1687-708X. PMC 2723755. PMID 19680452.
  4. ↑ Alemu, Abebe; Shiferaw, Yitayal; Addis, Zelalem; Mathewos, Biniam; Birhan, Wubet (17 January 2013). "Effect of malaria on HIV/AIDS transmission and progression". Parasites & Vectors. 6: 18. doi:10.1186/1756-3305-6-18. ISSN 1756-3305.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  5. ↑ "HIV and malaria interactions" (PDF). Retrieved 2025-08-29.
  6. ↑ Buck, Emily; Finnigan, Nancy A. (2025). "Malaria". StatPearls. StatPearls Publishing. PMID 31869175.
  7. ↑ Swinkels, Helena M.; Nguyen, Andrew D.; Gulick, Peter G. (2025). "HIV and AIDS". StatPearls. StatPearls Publishing. PMID 30521281. Archived from the original on 2023-09-19. Retrieved 2025-08-21.
  8. ↑ Ejigu, Solomon; Haile, Diresbachew; Solomon, Yerukneh (4 March 2022). "Effect of malaria and HIV/AIDS co-infection on red blood cell indices and its relation with the CD4 level of patients on HAART in Bench Sheko Zone, Southwest Ethiopia". PLOS ONE. 17 (3): e0263865. Bibcode:2022PLoSO..1763865E. doi:10.1371/journal.pone.0263865. ISSN 1932-6203. PMID 35245289.
  9. ↑ Alemu, Abebe; Shiferaw, Yitayal; Addis, Zelalem; Mathewos, Biniam; Birhan, Wubet (17 January 2013). "Effect of malaria on HIV/AIDS transmission and progression". Parasites & Vectors. 6 18. doi:10.1186/1756-3305-6-18. ISSN 1756-3305. PMC 3564906. PMID 23327493.
  10. ↑ Figueroa-Romero, Antía; Saura-Lázaro, Anna; Fernández-Luis, Sheila; González, Raquel (1 April 2024). "Uncovering HIV and malaria interactions: the latest evidence and knowledge gaps". The Lancet HIV. 11 (4): e255 – e267. doi:10.1016/S2352-3018(24)00035-3. ISSN 2352-3018. PMID 38458223.
  11. ↑ 11.0 11.1 Obeagu, Emmanuel Ifeanyi; Obeagu, Getrude Uzoma; Ubosi, Nwanganga Ihuoma; Uzoma, Ijeoma Chinwe; Tayrab, Eltayeb Mohamed Ahmed (5 April 2024). "Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life". Medicine. 103 (14): e37649. doi:10.1097/MD.0000000000037649. ISSN 1536-5964.
  12. ↑ Yibeltal, Tenaw; Abitew, Dereje Birhanu; Melese, Amsalu Birara; Mulu, Yared (30 November 2020). "Determinants of HIV-malaria co-infection among people living with HIV on anti-retroviral therapy in Northeast Ethiopia: unmatched case control study". Tropical Medicine and Health. 48 (1): 94. doi:10.1186/s41182-020-00286-9. ISSN 1348-8945.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  13. ↑ Takyi, Abena; Soma, Aboubakar; Przybylska, Marianna; Harriss, Eli; Barnes, Karen I.; Dahal, Prabin; Guérin, Philippe J.; Stepniewska, Kasia; Carrara, Verena I. (16 May 2025). "Efficacy of artemisinin-based combination therapy (ACT) in people living with HIV (PLHIV) diagnosed with uncomplicated Plasmodium falciparum malaria in Africa: a WWARN systematic review". Malaria Journal. 24 (1): 153. doi:10.1186/s12936-025-05393-8. ISSN 1475-2875. PMID 40380136.
  14. ↑ Zautner, Andreas Erich; Herchenröder, Ottmar; Moussi, Awatef El; Schwarz, Norbert Georg; Wiemer, Dorothea Franziska; Groß, Uwe; Frickmann, Hagen (March 2018). "Pharmaceutical interactions between antiretroviral and antimalarial drugs used in chemoprophylaxis". Acta Tropica. 179: 25–35. doi:10.1016/j.actatropica.2017.12.021. ISSN 1873-6254. PMID 29273442.
  15. ↑ Maganda, Betty A.; Ngaimisi, Eliford; Kamuhabwa, Appolinary AR; Aklillu, Eleni; Minzi, Omary MS (25 April 2015). "The influence of nevirapine and efavirenz-based anti-retroviral therapy on the pharmacokinetics of lumefantrine and anti-malarial dose recommendation in HIV-malaria co-treatment". Malaria Journal. 14 (1): 179. doi:10.1186/s12936-015-0695-2. ISSN 1475-2875. PMC 4424554. PMID 25906774.
  16. ↑ Seden, Kay; Gibbons, Sara; Marzolini, Catia; Schapiro, Jonathan M.; Burger, David M.; Back, David J.; Khoo, Saye H. (23 March 2017). "Development of an evidence evaluation and synthesis system for drug-drug interactions, and its application to a systematic review of HIV and malaria co-infection". PLOS ONE. 12 (3): e0173509. Bibcode:2017PLoSO..1273509S. doi:10.1371/journal.pone.0173509. ISSN 1932-6203. PMID 28334018.
  17. ↑ "Liverpool HIV Interactions". www.hiv-druginteractions.org. Retrieved 30 August 2025.
  18. ↑ Gumel, Shafi´u Dahiru; Ibrahim, Abdulrasul; Olayinka, Adebola Tolulope; Ibrahim, Muhammed Sani; Balogun, Muhammad Shakir; Dahiru, Afara; Ajayi, Ikeoluwapo; Ajumobi, Olufemi; Ahmadu, Isiyaku; Song, Abubakar; Maifada, Asma'u Ibrahim; Abdullahi, Habibu (28 February 2021). "HIV-Malaria co-infection and its determinants among patients attending antiretroviral treatment clinic in Zaria, Kaduna State, Nigeria". Journal of Interventional Epidemiology and Public Health. 4 (2). doi:10.37432/jieph.2021.4.1.31. ISSN 2664-2824. Archived from the original on 15 June 2025. Retrieved 18 August 2025.
  19. ↑ Gwitira, Isaiah; Murwira, Amon; Mberikunashe, Joseph; Masocha, Mhosisi (27 November 2018). "Spatial overlaps in the distribution of HIV/AIDS and malaria in Zimbabwe". BMC Infectious Diseases. 18 (1): 598. doi:10.1186/s12879-018-3513-y. ISSN 1471-2334. PMID 30482166.
  20. ↑ Barley, Kamal; Murillo, David; Roudenko, Svetlana; Tameru, Ana M. (2012). "A Mathematical Model of HIV and Malaria Co-Infection in Sub-Saharan Africa". Journal of AIDS & Clinical Research. 3 (7): 1–7. doi:10.4172/2155-6113.1000173. ISSN 2155-6113.
  21. ↑ González, Raquel; Ataíde, Ricardo; Naniche, Denise; Menéndez, Clara; Mayor, Alfredo (1 February 2012). "HIV and malaria interactions: where do we stand?". Expert Review of Anti-infective Therapy. 10 (2): 153–165. doi:10.1586/eri.11.167. ISSN 1478-7210. PMID 22339190. Retrieved 30 August 2025.
  22. ↑ Barsosio, Hellen C; Madanitsa, Mwayiwawo; Ondieki, Everlyne D; Dodd, James; Onyango, Eric D; Otieno, Kephas; Wang, Duolao; Hill, Jenny; Mwapasa, Victor; Phiri, Kamija S; Maleta, Kenneth; Taegtmeyer, Miriam; Kariuki, Simon; Schmiegelow, Christentze; Gutman, Julie R; ter Kuile, Feiko O (27 January 2024). "Chemoprevention for malaria with monthly intermittent preventive treatment with dihydroartemisinin–piperaquine in pregnant women living with HIV on daily co-trimoxazole in Kenya and Malawi: a randomised, double-blind, placebo-controlled trial". The Lancet. 403 (10424): 365–378. doi:10.1016/S0140-6736(23)02631-4. ISSN 0140-6736.
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