Malaria attributable to the HIV-1 epidemic, sub-Saharan Africa

Emerg Infect Dis. 2005 Sep;11(9):1410-9. doi: 10.3201/eid1109.050337.


We assessed the impact of HIV-1 on malaria in the sub-Saharan African population. Relative risks for malaria in HIV-infected persons, derived from literature review, were applied to the HIV-infected population in each country, by age group, stratum of CD4 cell count, and urban versus rural residence. Distributions of CD4 counts among HIV-infected persons were modeled assuming a linear decline in CD4 after seroconversion. Averaged across 41 countries, the impact of HIV-1 was limited (although quantitatively uncertain) because of the different geographic distributions and contrasting age patterns of the 2 diseases. However, in Botswana, Zimbabwe, Swaziland, South Africa, and Namibia, the incidence of clinical malaria increased by < or =28% (95% confidence interval [CI] 14%-47%) and death increased by < or =114% (95% CI 37%-188%). These effects were due to high HIV-1 prevalence in rural areas and the locally unstable nature of malaria transmission that results in a high proportion of adult cases.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • AIDS-Related Opportunistic Infections / complications*
  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / mortality
  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Age Distribution
  • CD4 Lymphocyte Count
  • Child
  • Child, Preschool
  • Communicable Diseases, Emerging* / etiology
  • Communicable Diseases, Emerging* / mortality
  • Communicable Diseases, Emerging* / transmission
  • HIV-1*
  • Humans
  • Incidence
  • Malaria* / etiology
  • Malaria* / mortality
  • Malaria* / transmission
  • Rural Health
  • Sentinel Surveillance
  • Urban Health