Abstract
Malaria/HIV-1 co-infection has become a significant public health problem in the tropics where there is geographical overlap of the two diseases. It is well described that co-infection impacts clinical progression of both diseases; however, less is known about the impact of co-infection on disease transmission. Malaria transmission is dependent upon multiple critical factors, one of which is the presence and viability of the sexual-stage gametocyte. In this review, we summarize evidence surrounding gametocyte production in Plasmodium falciparum and the development factors and the consequential impact that HIV-1 has on malaria parasite transmission. Epidemiological and clinical evidence surrounding anemia, immune dysregulation, and chemotherapy as it pertains to co-infection and gametocyte transmission are reviewed. We discuss significant gaps in understanding that are often due to the biological complexities of both diseases as well as the lack of entomological data necessary to define transmission success. In particular, we highlight special epidemiological populations, such as co-infected asymptomatic gametocyte carriers, and the unique role these populations have in a future focused on malaria elimination and eradication.
Highlights
Over the past several decades, malaria/HIV-1 co-infection has become a significant global public health problem in co-endemic areas of the world
This review focuses on parasite and host factors that influence malaria parasite transmission and highlights the efforts being made to elucidate the impact that HIV-1 may have on malaria transmission potential
Significant advances have been made in reducing the burden of malaria through classic vector control, case detection and treatment strategies; in an era focused on malaria eradication, more attention is being diverted to reduction and prevention of transmission
Summary
Over the past several decades, malaria/HIV-1 co-infection has become a significant global public health problem in co-endemic areas of the world. The geographical overlap between both diseases (Figures 1 and 2) combined with shared social determinants of health may explain the prevalence of co-infection, especially in sub-Saharan Africa (SSA). Some severely affected countries in SSA have an HIV-1 prevalence in adults above 10%, with more than 90% of the population exposed to malaria (World Health Organization, 2004). Data across epidemiologic populations of interest have consistently shown HIV-1-mediated immune deficiency is associated with higher prevalence of clinical malaria and increased parasite density (Hewitt et al, 2006; Flateau et al, 2011). Critical factors associated with parasite transmission such as host anemia and gametocyte density are likely altered when the host is infected with HIV-1 as well. This review acknowledges a substantial gap in research and understanding as the world continues to combat these two major global health priorities
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