The effect of HIV on morbidity and mortality in children with severe malarial anaemia

Details

• Alternative Title:
  Malar J
• Personal Author:
  Malamba, Samuel ; Hladik, Wolfgang ; Reingold, Arthur ; Banage, Flora ; McFarland, Willi ; Rutherford, George ; Mimbe, Derrick ; Nzaro, Esau ; Downing, Robert ; Mermin, Jonathan
• Description:
  Background
  
  Malaria and HIV are common causes of mortality in sub-Saharan Africa. The effect of HIV infection on morbidity and mortality in children with severe malarial anaemia was assessed.
  
  Methods
  
  Children <5 years old were followed as part of a prospective cohort study to assess the transfusion-associated transmission of blood-borne pathogens at Mulago Hospital, Kampala, Uganda. All children were hospitalized with a diagnosis of severe malarial anaemia requiring blood transfusion. Survival to different time points post-transfusion was compared between HIV-infected and uninfected children. Generalized estimating equations were used to analyse repeated measurement outcomes of morbidity, adjusting for confounders.
  
  Findings
  
  Of 847 children, 78 (9.2%) were HIV-infected. Median follow-up time was 162 days (inter-quartile range: 111, 169). HIV-infected children were more likely to die within 7 days (Hazard ratio [HR] = 2.86, 95% Confidence interval [CI] 1.30–6.29, P = 0.009) and within 28 days (HR = 3.70, 95% CI 1.91–7.17, P < 0.001) of an episode of severe malarial anaemia, and were more likely to die in the 6 months post-transfusion (HR = 5.70, 95% CI 3.54–9.16, P < 0.001) compared to HIV-uninfected children. HIV-infected children had more frequent re-admissions due to malaria within 28 days (Incidence rate ratio (IRR) = 3.74, 95% CI 1.41–9.90, P = 0.008) and within 6 months (IRR = 2.66, 95% CI 1.17 – 6.07, P = 0.02) post-transfusion than HIV-uninfected children.
  
  Conclusion
  
  HIV-infected children with severe malarial anaemia suffered higher all-cause mortality and malaria-related mortality than HIV-uninfected children. Children with HIV and malaria should receive aggressive treatment and further evaluation of their HIV disease, particularly with regard to cotrimoxazole prophylaxis and antiretroviral therapy.
  
  
• Subjects:
  AIDS-Related Opportunistic Infections Anemia Blood-Borne Pathogens Blood Transfusion Child, Preschool Cohort Studies Disease Transmission, Infectious HIV Infections Humans Infant Malaria Morbidity Prospective Studies Research

  More +
• Source:
  Malar J. 2007; 6:143.
• Document Type:
  Journal Article
• Volume:
  6
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8f9f5b2412a91f37e19d6af821b23d4f54f438d25274cc422c33a1ff45e6a0db
• Download URL:
  https://stacks.cdc.gov/view/cdc/3497/cdc_3497_DS1.pdf
• File Type:
  [PDF - 262.86 KB ]