Evaluation of standard diagnostic rapid test kits for malaria diagnosis among HIV patients in Kano, Nigeria

Epidemiology of malaria among HIV/AIDS patients in sub-Saharan Africa: A systematic review and meta-analysis of observational studies

Malaria related HIV morbidity and death is a concern in sub-Saharan Africa. Understanding the epidemiology of malaria among people living with HIV is vital for adequate intervention. We conducted a systematic review and meta-analysis to estimate the prevalence of malaria in HIV patients in sub-Saharan Africa. We searched PubMed, AJOL, Web of Science and Google Scholar databases. The overall pooled prevalence and pooled Odds Ratio (OR) with their 95% Confidence Intervals (CI) were estimated using the random-effects model and potential causes of heterogeneity in prevalence estimates were investigated using subgroup and meta-regression analysis. 58 studies, including 23,911 HIV patients, were identified between January 1990 and October 2020. The overall pooled prevalence of malaria in HIV patients was 22.7% (95% CI 18.0; 28.1). The Prevalence of malaria among HIV/AIDS patients was 33.1%, 30.2%, 15.3%, and 12.6% in Southern, Western, Central, and Eastern regions of SSA respectively. Prevalence of malaria in the central and western was higher [26.7% (95% CI 20.6; 33.9)] than 13.6% reported in the southern and eastern regions (95% CI 8.8; 20.5). There was a significant decrease in malaria prevalence among HIV/AIDS patients in the Eastern and Southern SSA regions from 21.9% (95% CI 15.5; 30.0) in the 2000-2010 period to 9.7% (95% CI 5.5-16.4) in the post-2010 period compared to the central and western regions. HIV infected patients with low CD4 + T cell count (CD4 < 200 cells/mm3) were 2.19 times more likely to become infected with malaria than those with high CD4 + T cell count (CD4 ≥ 200 cells/mm3) (pooled odds ratio (POR): 2.19 (95%CI 1.20;3.98), while patients on antiretroviral therapy (POR): 0.37 (0.23; 0.59), and in WHO clinical stages I and II (POR): 0.64 (0.28; 1.46), had a lower odds of been infected with malaria. Our review suggests that due consideration should be given to malaria among HIV/AIDS patients in SSA. In particular, the assessment and improvement of preventive measures for malaria/HIV co-infection in high-prevalence regions is important. For the treatment of both diseases, prophylaxis with cotrimoxazole and antiretroviral therapy should also be encouraged.

Malaria Parasite Density as a Predictor of Hematological Parameter Changes among HIV Infected Adults Attending Two Antiretroviral Treatment Clinics in Kano, Northwest Nigeria

Background

Despite public health significance of dual infections of human immunodeficiency virus (HIV) and malaria in developing countries like Nigeria, information on the association between malaria parasite density count (MPDC) and hematological parameter changes among HIV-infected individuals is rarely available.

Objectives

To evaluate burden of HIV and malaria dual infections and assess the predictive association of MPDC with hematological parameter changes among HIV infected adults attending two antiretroviral treatment clinics in Kano, Nigeria. Methodology. This was a cross-sectional study consisting of 1521 consented participants randomly selected between June 2015 and May 2016. Participants' basic characteristics and clinical details were collected using a pretested and validated standardized questionnaire. Collected venous blood was analyzed for malaria by rapid testing and microscopy including malaria parasite density; hematological parameters were estimated using a Sysmex XP-300 autoanalyzer. Data was reviewed, cleaned, and analyzed using SPSS software version 23.0. Mean hematological parameters and HIV/malaria status were compared using the independent t-test; hematological parameters and MPDC relationship was tested by simple linear regression analysis. Statistically significant difference at probability of <0.05 was considered for all variables.

Results

The majority (70.6%) of the participants were females. Mean (SD) age was 37.30 ± (10.41) years and ranged from 18 to 78 years. 25.4% of participants had dual infection, 99% due to Plasmodium falciparum species. Mean MPDC was 265 ± 31.8 (SD) cells/μl and ranged from 20 to 2500 cells/μl. Dual infection was highest (37.5%) among respondents in the age group ≥60 years. Prevalence was similar among other age groups (p = 0.165) and gender (p = 0.942). Of the 16 hematological parameters evaluated, 11 showed significant difference between HIV mono-infected and dual infected participants. Of the 11 parameters, only 7 (Hb, MCHC, red cells count, neutrophil and lymphocyte percentage, absolute lymphocyte count, and red cell distribution width) were significantly predictive of changes with respect to MPDC.

Conclusions

MPDC was significantly predictive of changes in 7 hematological parameters among dual infected participants in these settings. In routine malaria diagnosis, MPDC determination with respect to changes in some hematological parameters should be considered in ART programs for improved patient management.