Malaria and HIV co-infection: available evidence, gaps and possible interventions.

OBJECTIVES: To review the evidence of association between malaria and HIV/AIDS co-infection for purposes of developing strategies for malaria control.
DESIGN: Desktop review of literature.
SETTING: Harare, Zimbabwe. MAIN OUTCOME MEASURES: Response to treatment, development of severe malaria, malarial immunological response in HIV/AIDS positive people and incidence of malaria in HIV/AIDS positive individuals.
RESULTS: HIV-1 infection increases the incidence of Plasmodium falciparum parasitaemia and is associated with the development of severe malaria, commonly anaemia, cerebral malaria and high parasite density (OR = 2.56; 95% CI = 1.53 to 4.29; p < 0.001). The efficacy of chloroquine and sulphadoxine-pyrimethamine in reducing placental malaria in HIV-1 positive pregnant women was impaired compared to HIV-1 negative pregnant women. However, the situation in non-gravid HIV-1 positive people as regards efficacy of chloroquine and sulphadoxine-pyrimethamine prophylaxis is not known. Also not known is the relationship between malaria parasitaemia without symptoms and HIV-1 infection, the results of which may provide useful information regarding malaria control and prevention in HIV-1 positive people.
CONCLUSIONS: HIV-1 positive people staying in malaria endemic areas are at risk of developing severe malaria. Malaria prevention using insecticide-treated bednets and indoor residual house spraying may be the best available options for these people. Chloroquine and sulphadoxine-pyrimethamine prophylaxis require further studies to verify their efficacy, in the presence of HIV-1/AIDS infection.