HIV-1 immune suppression and antimalarial treatment outcome in Zambian adults with uncomplicated malaria

Background. Human immunodeficiency virus (HIV)-1 infected adults with low CD4 cell count have a higher risk of malaria infection and clinical malaria. We assessed the influence that HIV-1 immune suppression has on the efficacy of antimalarial treatment in adults with uncomplicated malaria Methods. This clinical trial included 971 Zambian adults with uncomplicated malaria. Patients were tested for HIV-1, and, if positive, a CD4 cell count was assessed. The primary outcome was recurrent parasitemia corrected by molecular genotyping within 45 days after treatment. Results. HIV-1 infection was detected in 33% (320/971) of adult patients with malaria. Treatment failure was not associated with HIV-1 infection (relative risk [RR], 1.12 [95% confidence interval {CI}, 0.82-1.53];). Pp. 45 HIV-1-infected patients with a CD4 cell count < 300 cells/mu L had an increased risk of recurrent parasitemia, compared with those with a CD4 cell count >= 300 cells/mu L (RR, 2.24 [95% CI, 1.20-4.14]; P = .01). After notyping, the risk of recrudescence was higher in HIV-1-infected patients with a CD4 cell count >= 300 cells/mu L than in the other patients with malaria (RR, 1.67 [95% CI, 1.13-2.47] P = .01). Conclusion. HIV-1-infected patients with malaria with a CD4 cell count < 300 cells/mu L have a higher risk of experiencing a recrudescent infection, compared with those with a CD4 cell count >= 300 cells/mu L or without HIV-1 infection.