Presence of Plasmodium falciparum DNA in Plasma Does Not Predict Clinical Malaria in an HIV-1 Infected Population.

TitlePresence of Plasmodium falciparum DNA in Plasma Does Not Predict Clinical Malaria in an HIV-1 Infected Population.
Publication TypeJournal Article
Year of Publication2015
AuthorsOrlov M, Smeaton LM, Kumwenda J, Hosseinipour MC, Campbell TB, Schooley RT
JournalPLoS One
Volume10
Issue6
Paginatione0129519
Date Published2015
ISSN1932-6203
KeywordsAdolescent, Adult, Aged, DNA, Protozoan, Female, HIV Infections, HIV-1, Humans, Malaria, Male, Middle Aged, Parasitemia, Plasmodium falciparum, Prevalence, Young Adult
Abstract

BACKGROUND: HIV-1 and Plasmodium falciparum malaria cause substantial morbidity in Sub-Saharan Africa, especially as co-infecting pathogens. We examined the relationship between presence of P. falciparum DNA in plasma samples and clinical malaria as well as the impact of atazanavir, an HIV-1 protease inhibitor (PI), on P. falciparum PCR positivity.

METHODS: ACTG study A5175 compared two NNRTI-based regimens and one PI-based anti-retroviral (ARV) regimen in antiretroviral therapy naïve participants. We performed nested PCR on plasma samples for the P. falciparum 18s rRNA gene to detect the presence of malaria DNA in 215 of the 221 participants enrolled in Blantyre and Lilongwe, Malawi. We also studied the closest sample preceding the first malaria diagnosis from 102 persons with clinical malaria and randomly selected follow up samples from 88 persons without clinical malaria.

RESULTS: PCR positivity was observed in 18 (8%) baseline samples and was not significantly associated with age, sex, screening CD4+ T-cell count, baseline HIV-1 RNA level or co-trimoxazole use within the first 8 weeks. Neither baseline PCR positivity (p = 0.45) nor PCR positivity after initiation of antiretroviral therapy (p = 1.0) were significantly associated with subsequent clinical malaria. Randomization to the PI versus NNRTI ARV regimens was not significantly associated with either PCR positivity (p = 0.5) or clinical malaria (p = 0.609). Clinical malaria was associated with a history of tuberculosis (p = 0.006) and a lower BMI (p = 0.004).

CONCLUSION: P. falciparum DNA was detected in 8% of participants at baseline, but was not significantly associated with subsequent development of clinical malaria. HIV PI therapy did not decrease the prevalence of PCR positivity or incidence of clinical disease.

DOI10.1371/journal.pone.0129519
Alternate JournalPLoS ONE
PubMed ID26053030
PubMed Central IDPMC4460081
Grant List1U01AI068634 / AI / NIAID NIH HHS / United States
1U01AI068636 / AI / NIAID NIH HHS / United States
1U01AI069423 / AI / NIAID NIH HHS / United States
1U01AI069432 / AI / NIAID NIH HHS / United States
T32 GM007198 / GM / NIGMS NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069518 / AI / NIAID NIH HHS / United States