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ORIGINAL ARTICLE
Year : 2016  |  Volume : 10  |  Issue : 1  |  Page : 11-15

Prevalence of malaria among HIV patients on highly active antiretroviral therapy in Kogi State, North Central Nigeria


1 Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City, Nigeria
2 Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
3 School of Medical Laboratory Sciences, University of Benin Teaching Hospital, Benin City, Nigeria
4 Ministry of Health, General Hospital, Obangede, Nigeria
5 Ministry of Health, Zonal Hospital, Okene, Nigeria
6 Ministry of Health, Okene, Kogi State, Nigeria

Date of Web Publication6-Sep-2016

Correspondence Address:
Frederick Olusegun Akinbo
Department of Medical Laboratory Science, School of Basic Medical Sciences, University of Benin, Benin City
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.189802

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   Abstract 

Background: Malaria and HIV diseases kill millions of people yearly, and they are the scourges of developing nations. This study was conducted to determine the coinfections of malaria and HIV, and the effect of demographic characters on HIV-infected patients receiving highly active antiretroviral therapy (HAART) in Kogi State, Nigeria.
Methods: Five hundred and eleven participants consisting of 411 (51 males and 360 females) HIV-infected patients on HAART and 100 (8 males and 92 females) apparently healthy HIV-noninfected individuals who served as controls were enrolled in this study. Blood sample was collected from each participant and malaria was diagnosed using the standard procedure.
Results: An overall prevalence of 7.8% and 2% of malarial infection was observed in HIV-infected patients on HAART and non-HIV participants, respectively. The prevalence of malaria among HIV patients on HAART differed signifi cantly (P < 0.0001) among the local government councils, with patients from Ogori-Magongo having the least prevalence (0.0%). Age, gender, type of occupation, clinical manifestations, anemia, and CD4+ T-cell count <200 cells/μL affected the prevalence of malarial infection (P < 0.05) in this study.
Conclusion: Diagnosis of malaria among HIV patients on HAART is advocated.

Keywords: Highly active antiretroviral therapy, HIV, Kogi State, Malaria


How to cite this article:
Akinbo FO, Anate PJ, Akinbo DB, Omoregie R, Okoosi S, Abdulsalami A, Isah B. Prevalence of malaria among HIV patients on highly active antiretroviral therapy in Kogi State, North Central Nigeria. Ann Nigerian Med 2016;10:11-5

How to cite this URL:
Akinbo FO, Anate PJ, Akinbo DB, Omoregie R, Okoosi S, Abdulsalami A, Isah B. Prevalence of malaria among HIV patients on highly active antiretroviral therapy in Kogi State, North Central Nigeria. Ann Nigerian Med [serial online] 2016 [cited 2020 Sep 23];10:11-5. Available from: http://www.anmjournal.com/text.asp?2016/10/1/11/189802


   Introduction Top


Plasmodium falciparum infection is known to be endemic in most tropical countries and will obviously infect HIV-infected patients in this part of the world at one time or the other during the course of its infection.[1] There are five known species of Plasmodium that infect human beings, namely, P. falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, and Plasmodium knowlesi. The species differs in morphology, characteristics, and geographical distribution. Of these, P. falciparum is the most predominant species and carries a substantial risk of death, causing the most morbidity and mortality.[2],[3]

Malaria and HIV diseases kill millions of people yearly, and they are the scourges of developing nations.[4] An estimated 225 million cases of malaria with 176 million in the sub-Saharan Africa and 49 million in other parts of the world were reported in 2009.[5] Globally, an estimated 33 million people are currently with HIV, of which 22.5 million are in sub-Saharan Africa with its attendant death toll in this region.[6] Given the overlap of their geographic distribution and resultant rates of coinfection, interactions between the two diseases pose major public health problems. These diseases together accounted for over 3 million deaths in 2007, and millions more are adversely affected each year.[7]

The reduction of CD4+ T-cells at late stages of HIV infection results in decreased CD8+ T-cells counts and function, thereby causing a severe change in the immune response against other agents of disease including Plasmodium.[8] Parasitemia is more common among HIV-infected patients, as lower CD4+ counts are associated with higher parasite densities.[9]

The advent of highly active antiretroviral therapy (HAART) has been reported to reduce the morbidity and mortality caused by HIV infection. Despite the introduction of HAART, there are reports of malarial infection among HIV-infected patients on HAART and artemisinin-based combination therapy (ACT). In Uganda, a prevalence of 5% of asymptomatic malaria was reported among HIV-infected patients receiving HAART.[10] Elsewhere, in Benin City, Nigeria, it was noted that HIV-infected patients on HAART and ACT had a prevalence of 2.1%[11] and 9.8%. respectively.[12] Information is lacking on the coinfections of malaria and HIV-infected patients receiving HAART in Kogi State, Nigeria. Thus, the aim of this study was to determine the prevalence of Plasmodium infections among HIV-infected patients on HAART in Kogi State, Nigeria.


   Materials and Methods Top


Study area

Kogi State is situated in the North Central region of Nigeria, and it lies roughly between 07° 45'0 N and 06° 45'0 E. The state is located within the low rain forest zone of Nigeria and has two seasons, dry and wet. The dry season spans from mid-October to March whereas the rainy season lasts between April and September. The state consists of 21 local government councils divided into three senatorial districts – Kogi North, Kogi Central, and Kogi South. The study was conducted in four local government councils of Kogi Central senatorial district.

Study population

This study was carried out at the General Hospitals and Comprehensive Health Centers in Kogi State. These health institutions are main hospitals in the municipality of Kogi State and are also designated for HIV management. Five hundred and eleven participants consisting of 411 (51 males and 360 females) HIV patients on HAART and 100 (8 males and 92 females) apparently healthy non-HIV-infected individuals who served as controls were recruited for this study. The HAART regimens used by HIV-infected patients consist of zidovudine, lamivudine, and nevirapine. HAART-naive HIV patients and those with AIDS-defining conditions were excluded from the study. A predesigned structured questionnaire was administered to collect bio data and sociodemographic characteristics from the participants. Ethical approval for the study was obtained from the Ethical Committee of the State Ministry of Health, Kogi State, Nigeria.

Sample collection and processing

Five milliliters of venous blood was collected from each participant and it was dissolved into ethylenediaminetetraacetic acid and mixed. Malaria was diagnosed by using a previously described method.[12] In brief, thick and thin blood films were made for detection and confirmation of parasitemia. Both films were stained in 10% Giemsa solution for 30 min and examined for Plasmodium microscopically using oil immersion lens. Two hundred fields per film were examined.[4]

CD4+ T-lymphocyte cell count was analyzed using flow cytometry (Partec, Germany) while hemoglobin concentration was determined using an hematological analyzer - Sysmex KX-21 (Sysmex Corporation, Kobe, Japan).

Anemia was defined as hemoglobin concentration <12 g/dl for females and <13 g/dl for males according to the WHO criteria.[13]

Data analysis

Proportions between the two groups were compared by calculating odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Statistical significance was determined using the Chi-square test.


   Results Top


A total of 32 (7.8%) out of 411 HIV patients on HAART and 2 (2.0%) out of the 100 non-HIV individuals had malarial infection. The prevalence did not differ significantly (P = 0.0631) between the two groups [Table 1].
Table 1: Prevalence of malarial infection among HIV patients and non-HIV participants

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The prevalence of malaria among HIV patients on HAART differed significantly (P < 0.0001) among the local government councils, with patients from Ogori-Magongo having the least prevalence (0.0%) [Table 2].
Table 2: Prevalence of malarial infection among HIV patients on highly active antiretroviral therapy in local government councils

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The prevalence of malarial infection among HIV patients on HAART dropped from 36.7% in the age group of 19–24 years to 2.8% in the age group of 43–48 years, and then it began to rise. Age significantly affected the prevalence of malarial infection among HIV patients on HAART, with the age group of 19–24 years having the highest prevalence [Table 3]. Male gender was a significant risk factor for acquiring malarial infection among HIV patients on HAART (OR = 2.64; 95% CI = 1.164–6.001; P = 0.03). In relation to patients' occupation, clinical manifestation, and malaria preventive measures, patients who were farmers (P = 0.0013), feverish (P < 0.0001), and use window netting as preventive measures (P < 0.0001) had significantly a higher prevalence of malaria [Table 3].
Table 3: Effect of demographic characteristics on the prevalence of malarial infection among HIV-infected patients on highly active antiretroviral therapy

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The prevalence of anemia was significantly higher (P < 0.01) in HIV patients on HAART with malaria compared with their non-HIV counterparts. Indeed, malaria was associated (OR = 4.023 95% CI = 1.43–11.36) with anemia among HIV patients on HAART [Table 4].
Table 4: Relationship between anemia and malarial infection

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CD4+ T-lymphocyte count <200 cell/µL was a significant risk factor for acquiring malarial infection among HIV patients on HAART (OR = 40.652; 95% CI = 16.913–97.714; P < 0.0001) [Table 5].
Table 5: Effect of CD4+ T-lymphocyte counts on malaria

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   Discussion Top


The coinfections between HIV and other infective agents, including parasites, influence the health status of people living with HIV/AIDS.[14] It has now been established that HIV affects the susceptibility to malaria, its clinical course, and also impairs antibody responses to malarial antigens.[15]

An overall prevalence of 7.8% of P. falciparum among HIV patients on HAART was observed in this study. This is higher than the 2.11% reported by Akinbo and Omoregie [11] in Benin City, Nigeria, and the 4% observed in Uganda.[10] However, it is lower than the 9.78% observed in Benin City, Nigeria, by Akinbo et al.[12] In this study, the prevalence of malaria did not differ significantly between the HIV patients and the non-HIV participants (P = 0.0631). HAART has been reported to improve immunity.[16] Perhaps, the improved immunity may be responsible for this finding. Another plausible reason for this finding is the recent report that some drugs in the HAART regimen have anti-Plasmodium activity.[17] In that report, nevirapine and lamivudine were shown to inhibit the growth of Plasmodium in vitro.[18] Nevirapine and lamivudine were among the HAART regimens given to the HIV patients.

HIV patients from Ajaokuta local government council had the highest prevalence (23.3%) of malaria compared with their counterparts from other local government councils (P < 0.0001). Ajaokuta local government council is the only council among those tested that the River Niger passes through. A number of tributaries from the River Niger can be found in Ajaokuta local government council. These bodies of water are used by the people for farming and domestic purposes. The water can serve as breeding grounds for mosquitos and ultimately increase malaria transmission. This may explain the findings in this study.

The prevalence of malaria was significantly higher in the age group of 19–24 years (P< 0.0001). This age group may be involved in activities that increase their chances of been bitten by mosquitoes and consequently increase malaria parasite transmission. This may be the reason for our finding. Male gender was associated with malaria (OR = 2.643; 95% CI = 1.164–6.001; P = 0.0328). Males are more likely to stay outside late and be without shirts as they carry out their activities, and are, therefore, more likely to be bitten by mosquitoes. In a similar vein, farmers are more likely to work without upper body clothing and around bodies of water. Thus, increasing their chances of been bitten by mosquitos. This may explain why farmers have significantly (P = 0.0013) higher prevalence of malaria than HIV patients with other observed occupation in this study. HIV patients without symptoms of malaria had no malarial parasite detected in their blood. This is not in agreement with the previous studies.[11],[12] The reason for this is unclear. Fever was the symptom mostly associated with malaria in the previous studies.[18],[19] This agrees with the findings in this study. HIV patients on HAART who slept under insecticide-treated bed nets (ITNs) had the least prevalence of malaria (1.4%) in this study. This confirms the effectiveness of this preventive measure. Therefore, HIV patients are advised to use ITNs as malaria preventive measures.

HIV patients on HAART with malaria had 1–56-fold higher risk of developing anemia when compared with their non-HIV counterparts (OR = 7.516; 95% CI = 1.011–55.878; P = 0.0382). The finding of malaria and anemia among HIV patients on HAART agrees with a previous report.[11] The presence of zidovudine among the HAART regimen, infections such as malaria, and production of antibodies to HAART agents have been reported to be the causes of anemia among HIV patients on HAART.[15],[20],[21]

CD4+ T-cell counts are used as a measure of immunity and HIV disease progression,[22] and counts <200 cells/μL increase the risk of opportunistic infections. In the current investigation, HIV patients on HAART with CD4+ T-cell counts <200 cells/μL were at a risk of acquiring malarial infection (OR = 25.394 95% CI = 11.25, 57.32;P< 0.01).

This finding is consistent with a previous report.[11] This may indicate that patients on HAART whose immunity may not have fully recovered are still susceptible to malarial infection.


   Conclusion Top


This study reveals a prevalence of 7.8% of malarial infection among HIV patients on HAART. Age, gender, type of occupation, clinical manifestations, anemia, and CD4+ T-cell count <200 cells/μL affected the prevalence of malarial infection in this study. Diagnosis of malaria among HIV patients on HAART is advocated.

This study reveals a prevalence of 7.8% of malarial infection among HIV patients on HAART. Age, gender, type of occupation, clinical manifestations, anemia, and CD4+ T-cell count <200 cells/μL affected the prevalence of malarial infection in this study. Diagnosis of malaria among HIV patients on HAART is advocated.

Acknowledgments

We acknowledge the Kogi State Hospital Management Board for granting permission to carry out this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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