Human immunodeficiency virus (HIV) and malaria interaction in sub-Saharan Africa: the collision of two Titans

HIV and malaria are among the leading causes of morbidity and mortality in sub-Saharan Africa, home to 10% of the world's population. An association between HIV and malaria is expected in theory, however, there is conflicting evidence regarding the impact of HIV infection on parasite loads. HIV-associated immunosuppression contributes to more frequent and more severe malaria and reduced efficacy of antimalarials in pregnant women and adults. These effects are modified by the endemicity and stability of malaria transmission. Co-infection with malaria and HIV in pregnant women is associated with anemia, low birth weight, and increased risk of infant mortality to a greater extent than infection with either disease alone. Studies investigating the impact of placental malaria on mother-to-child HIV-1 transmission continue to show conflicting results. This article attempts to review the pertinent information available about the interaction between HIV and malaria and information about chemoprophylaxis and treatment issues. Although much has been published in the last 10 years regarding the interaction of HIV and malaria in sub-Saharan Africa, we still need more information so as to understand the issues that will help us develop effective programs.