Abstract
Co-infection with malaria and human immunodeficiency virus (HIV) increases the severity and mortality rates of both diseases. A better understanding of the effects of co-infections could help in the diagnosis, prompt treatment, prevention, and control of malarial parasites among HIV-infected patients. In this systematic review and meta-analysis, we estimated the prevalence and characteristics of severe malaria (SM) caused by co-infection with HIV. We included relevant studies that were conducted between the years 1991 and 2018 and reporting on SM. We pooled the prevalence of SM in patients with co-infection, pooled odds ratios of SM in patients with co-infection and Plasmodium mono-infection, and differences in laboratory parameters such as parasite density and leucocyte counts, between co-infected and Plasmodium mono-infected patients. The meta-analysis included 29 studies (1126 SM cases). The pooled prevalence of SM in co-infected patients using the data of 23 studies (SM = 795 cases, all co-infection cases = 2534 cases) was 43.0% (95% confidence interval [CI] 31.0–56.0%; I2, 98.0%). Overall, the odds of SM from 18 studies were pooled. The odds of SM were significantly higher in co-infected patients than in Plasmodium mono-infected patients (OR 2.41; 95% CI 1.43–4.08; I2 = 85%; P = 0.001) and also significantly higher in children (OR 9.69; 95% CI 5.14–18.3; I2, 0%; P < 0.0001; two studies) than in adults (OR 2.68; 95% CI 1.52–4.73; I2, 79.0%; P = 0.0007; 12 studies). Co-infected patients with SM had a higher parasite density than those with Plasmodium mono-infection when the data of seven studies were analysed (SMD, 1.25; 95% CI 0.14–2.36; I2, 98.0%; P = 0.03) and higher leukocyte counts when the data of four studies were analysed (MD, 1570 cells/µL; 95% CI 850–2300 cells/µL; I2, 21.0%; P < 0.0001). Thus, the prevalence of SM among patients co-infected with Plasmodium spp. and HIV is high. Because co-infections could lead to SM, patients with Plasmodium spp. and HIV co-infection should be identified and treated to reduce the prevalence of SM and the number of deaths.
Highlights
Malaria remains one of the most dangerous diseases affecting the world’s population with about 228 million cases and 405,000 deaths from malaria g lobally1; most of the malaria cases (93%) and deaths (94%) were found in the African Region1
5169 articles remained for further consideration
A total of 29 studies were included in the systematic review and meta-analysis
Summary
Malaria remains one of the most dangerous diseases affecting the world’s population with about 228 million cases and 405,000 deaths from malaria g lobally; most of the malaria cases (93%) and deaths (94%) were found in the African Region. Co-infection with Plasmodium spp. and HIV is likely to occur because of the high prevalence of both infections in the same areas, in Sub-Saharan African regions. Previous studies demonstrated that adults infected with HIV were at increased risk of developing severe m alaria. Almost all patients with Plasmodium spp. and HIV co-infection develop a naemia. A previous meta-analysis of 23 studies demonstrated that the development of anaemia increased by 49% in co-infected pregnant women compared with those who had HIV in mono-infection. The primary aim of our study was to generate a pooled prevalence estimate of SM among patients co-infected with Plasmodium spp. and HIV. The third aim was to identify the differences in laboratory parameters between patients with Plasmodium spp. and HIV co-infection and those with Plasmodium mono-infection
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