Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi:: a prospective cohort study
Effect of Plasmodium falciparum malaria on concentration of HIV-1-RNA in the blood of adults in rural Malawi:: a prospective cohort study
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DOI：
10.1016/s0140-6736(05)17743-5
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发表时间：
2005-01-15
期刊：
影响因子：
168.9
通讯作者：
Molyneux, ME
中科院分区：
文献类型：
--
作者：
Kublin, JG;Patnaik, P;Molyneux, ME
背景血液中HIV病毒载量的升高与疾病进展的加速和感染传播的增加有关。为了评估恶性疟原虫疟疾对血液中HIV浓度的影响，我们在马拉维进行了一项前瞻性队列研究。方法我们招募了367名HIV-1感染的成年人。在基线时的334人中，148人在随访期间至少有一次疟疾发作并接受了抗疟治疗。其中，77人在基线、疟疾期间和疟疾后进行了HIV-1-RNA测量。我们使用线性回归和广义估计方程来评估疟疾的四种定义的效果（任何寄生虫血症、寄生虫密度大于或等于2000/穆尔、发热性寄生虫血症和寄生虫密度大于或等于2000/穆尔的发热性寄生虫血症）对log HIV-1 RNA的变化、总体和基线CD 4计数的影响。HIV-1-RNA浓度在基线（中位数96 215拷贝/mL）和疟疾（168 901拷贝/mL）之间几乎翻了一番，平均RNA浓度增加了0.25（95% CI 0.11-0.39）log。HIV-1-RNA浓度在疟疾后约8-9周降至中位数82058拷贝/mL。HIV-1-RNA在发热、寄生虫密度≥ 2000/穆尔、CD 4计数> 300个细胞/μ L的人群中增加最多，其浓度从基线时的中位数38483拷贝/mL上升至疟疾期间的196098拷贝/mL，平均对数增加0.82（95%CI 0.55-1.10，p
Background Raised HIV viral load in blood has been associated with accelerated disease progression and increased transmission of infection. To assess the effect of Plasmodium falciparum malaria on concentrations of HIV in blood, we did a prospective cohort study in Malawi.Methods We recruited 367 HIV-1-infected adults. Among 334 people aparasitaemic at baseline, 148 had at least one malaria episode during follow-up and received antimalarial treatment. Of these, 77 had HIV-1-RNA measurements at baseline, during malaria, and post-malaria. We used linear regression with generalised estimating equations to assess effect of four definitions of malaria (any parasitaemia, parasite density greater than or equal to2000/muL, febrile parasitaemia, and febrile parasitaemia with parasite density greater than or equal to2000/mul) on changes in log HIV-1 RNA, overall and by baseline CD4 count.Findings With malaria defined as any parasitaemia, HIV-1-RNA concentration almost doubled between baseline (median 96 215 copies per mL) and malaria (168 901 copies per mL), a 0.25 (95% CI 0.11-0.39) log increase in mean RNA concentration. HIV-1-RNA concentration fell to median 82 058 copies per mL by about 8-9 weeks postmalaria. Increases in HIV-1-RNA were greatest for people with fever, parasite density 2000/muL or greater, and CD4 count more than 300 cells per p,L, in whom concentrations rose from median 38 483 copies per mL at baseline to 196 098 copies per mL during malaria, a mean log increase of 0.82 (95% CI 0.55-1.10, p