Dual HIV and Malaria Infection Potentiates the Spread of Both Diseases

Summary and Comment |
January 22, 2007

Dual HIV and Malaria Infection Potentiates the Spread of Both Diseases

  1. Salim S. Abdool Karim, MD, PhD

In a mathematical model applied to a Kenyan community of about 200,000 people, dual infection was estimated to have resulted in 8500 excess HIV infections and almost 1 million excess malaria episodes since 1980.

  1. Salim S. Abdool Karim, MD, PhD

HIV-infected individuals have an increased susceptibility to malaria infection, and malaria has been shown to induce HIV replication. In an HIV-infected individual, acute malaria infection leads to a viral-load spike that could potentially increase the likelihood of HIV transmission (ACC Mar 1 2005). In the absence of empiric data on the interplay between HIV and malaria, investigators developed a mathematical model to estimate the effect of recurrent malaria on HIV transmission and the effect of HIV infection on malaria incidence.

Using data from Kisumu, Kenya, the model shows that the interaction between the two diseases resulted in an 8% higher peak in prevalence for HIV and a 13% higher peak for malaria. These values translate to a cumulative excess of 8500 HIV infections and 980,000 malaria infections in the region since 1980. In areas where malaria and HIV prevalence are both high or both low, the interaction is minimal. Areas most likely to experience the brunt of the interaction are those with a high HIV prevalence and low or unstable malaria prevalence and those with a high malaria prevalence and low HIV prevalence.

Investigators also modeled the effect of malaria treatment for HIV-infected individuals by varying the infectious period of malaria from 0 to 60 days; a steady decline in excess HIV infections was observed as duration of malaria episodes decreased. The model was also used to estimate the effect of reduced sexual activity during malaria episodes; with a 36% reduction in such activity, the excess prevalence of HIV infection was completely removed.

Comment

This statistical modeling exercise suggests that dual infection with HIV and malaria plays a key role in fueling the spread of both diseases in sub-Saharan Africa. The increase in HIV viral load resulting from recurrent malaria may be an important factor in promoting the spread of HIV in this region. This model points to the added benefit of effective treatment and prevention of HIV on the spread of malaria and vice versa.

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