Treatment, Prevention Complications Caused by Overlap of Malaria and HIV

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Malaria and HIV are two of the leading causes of death worldwide and previous research shows that they often exacerbate one another, particularly in Sub-Saharan Africa where both are extremely common.

There are currently gaps in research and conflicting regional evidence explaining the connection in depth. The last WHO report dates from 2004. To address the ambiguity and to treat and prevent the spread of these infections in vulnerable populations, a research team led by Antía Figueroa-Romero, MA, a junior epidemiologist at the Barcelona Institute for Global Health in Spain, reviewed and compiled the current knowledge about the connection between malaria and HIV. The results of the review were published earlier this month in The Lancet.

Malaria and HIV overlap in tropical regions disproportionately affected by social and economic stressors. For these reasons, Sub-Saharan Africa is a hotspot for both infections, particularly in the southeastern African countries including Zambia, Zimbabwe, Mozambique and Malawi. There is little evidence for coinfections in Western Africa which could be attributed to differences in disease replications, infectiousness of dominant HIV subtypes and circumcision rates, the Lancet review reads. Southeast Asia, Latin America and the Caribbean are also affected to a lesser extent.

In 2022, there were an estimated 249 million cases of malaria worldwide. Sub-Saharan Africa accounted for about 94% of those cases and 95% of malaria-related deaths, according to the study. Almost the entire population of these countries (90%) has been exposed to malaria.

An estimated 67% of people living with HIV also reside in Sub-Saharan Africa. HIV can increase the infection risk of malaria because the immune system is weakened against infection by the unicellular protozoan parasites belonging to the genus Plasmodium that cause malaria. The prevalence of coinfection is about 19%.

If an individual already has malaria and HIV, malaria can increase the HIV viral load and there is a possible risk increase of vertical transmission. There is also a heightened risk for cerebral malaria, which is characterized by the accumulation of infected red blood cells in the brain which can lead to a blockage. However, this data is based on early studies with HIV-positive people who are not on ART, according to Figueroa-Romero's study.

Treating them simultaneously becomes difficult because of the potential drug interactions between antimalarial medication and antiretroviral therapy. There are mixed results when it comes to drug combinations.

In pregnant individuals, there are adverse outcomes for both mother and child. Both have an increased risk of death, low birth weight and a decrease in malaria antibodies.

Prevention of malaria in people living with HIV includes indoor insect repellent and insecticide nets to sleep under.

“Discrepancies persist in terms of how malaria influences HIV transmission across sub-Saharan Africa. Eastern areas of the region with high prevalence of malaria and HIV show a doubling of HIV infection risk, whereas in western areas, with lower HIV rates, there is little evidence of a significant association between HIV and malaria,” Figueroa-Romero and her colleagues wrote. “Considering HIV and malaria interactions in the develop­ment of control guidelines and both disease elimination plans is essential.”