A research report submitted to the School of Public Health , University of Witwatersrand Johannesburg in partial fulfillment of the requirements for the degree of Masters of Science in Epidemiology and Biostatistics, November 2013 / Malaria in HIV-infected (HIV+) persons is associated with reduced immunity due to a
decrease in CD4+ cells count and an increase in viral load, and immunity becomes more
compromised in HIV-infected ART-naïve patients. However, the relationship between
treatment of HIV infection with antiretroviral therapy (ART) and malaria among HIV coinfected
individuals has not been widely reported in Africa, in particular amongst Rwandan
women. In this study, the investigator examined malaria incidence and its associated potential
risk factors in a cohort of HIV-uninfected, HIV-infected on ART and HIV-infected naïve
Rwandan women.
Method
The data used in this research consists of 936 women enrolled in the Rwandan Women's
Inter-association Study and Assessment (RWISA) study. Follow-up visits were carried out
every 6 months for a period of 5 years. Incidence of malaria was considered as self-reported
if it occurred during the 6 months prior to the study visit. Incidence rates (IRs) and Hazard
ratios (HRs) with 95% CI were determined in HIV-uninfected, HIV-infected ART-naïve and
HIV-infected on ART groups. Predictors of malaria incidence in these groups were estimated
by Hazard ratios (HR, 95% CI) using Cox regression adjusted for potential confounders.
Results
Of the 936 women enrolled in the study (226 HIV-uninfected and 710 HIV-infected), almost
90% of the women reported malaria during the follow-up period. At the baseline visit, the
median age of the participants was lower among HIV-infected women at 34 years ([IQR] 30-
39), compared to that of HIV-uninfected women at 43 years ([IQR] 34-49), P<0.01.
In both groups of HIV-infected and HIV-uninfected women, a large number were widowed
i.e. 49% vs. 42%, P<0.01
The HIV-infected women had lower educational status (67% vs. 57%, P<0.01) and lower
employment opportunities (68% vs 72%, P=0.002) than HIV-uninfected women. Of the HIVuninfected
women, 174 (77%) and of HIV-infected women 596 (84%) reported that they did
not have enough food to eat.
Malaria incidence was higher in HIV-infected ART-naïve women [adjusted HR= 1.2, 95%
CI (1.01-1.36), P=0.03], when compared to HIV-infected women on ART. However, when
malaria incidence was compared according to HIV status, HIV-infected women showed a
significantly lower incidence when compared to their HIV-uninfected counterparts [adjusted
HR= 0.8, 95% CI (0.69- 0.97), P=0.02]. The independent predictors of malaria incidence in
the cohort were unemployment, lower level of education, age and season.
Conclusion
HIV-infected antiretroviral-naïve women in malaria-endemic areas are at higher risk of
malaria than HIV-infected women on antiretroviral therapy. In countries where both diseases
overlap, the indirect effect of HIV treatment with combination antiretroviral therapy could
reduce malaria burden. These findings suggest that additional malaria prevention efforts
should be aimed at the untreated HIV-infected population.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/14502 |
| Date | 04 April 2014 |
| Creators | Umunyana, Jacqueline |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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