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Review
. 2005 Sep;11(9):1410-9.
doi: 10.3201/eid1109.050337.

Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa

Eline L Korenromp  1 , Brian G Williams, Sake J de Vlas, Eleanor Gouws, Charles F Gilks, Peter D Ghys, Bernard L Nahlen
Affiliations
Review

Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa

Eline L Korenromp et al. Emerg Infect Dis. 2005 Sep.

Abstract

We assessed the impact of HIV-1 on malaria in the sub-Saharan African population. Relative risks for malaria in HIV-infected persons, derived from literature review, were applied to the HIV-infected population in each country, by age group, stratum of CD4 cell count, and urban versus rural residence. Distributions of CD4 counts among HIV-infected persons were modeled assuming a linear decline in CD4 after seroconversion. Averaged across 41 countries, the impact of HIV-1 was limited (although quantitatively uncertain) because of the different geographic distributions and contrasting age patterns of the 2 diseases. However, in Botswana, Zimbabwe, Swaziland, South Africa, and Namibia, the incidence of clinical malaria increased by < or =28% (95% confidence interval [CI] 14%-47%) and death increased by < or =114% (95% CI 37%-188%). These effects were due to high HIV-1 prevalence in rural areas and the locally unstable nature of malaria transmission that results in a high proportion of adult cases.

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Figures

Figure 1
Figure 1
Modeled time trends in HIV-1 prevalence (adults 15–49 years), based on UNAIDS estimates from sentinel surveillance data in antenatal clinics (28).
Figure 2
Figure 2
Modeled time trends in CD4 count distributions (per microliter) among HIV-infected adults in selected African countries. Madagascar: example of a rising HIV-1 epidemic at low grade; Ghana: example of a stable epidemic at low grade; Uganda: example of a high-grade epidemic that has declined and leveled off; South Africa: example of a high-grade epidemic that recently started leveling off.
Figure 3
Figure 3
Estimated proportional increases in malaria deaths due to HIV-1 in sub-Saharan African countries in 2004, for all ages combined.
See this image and copyright information in PMC

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