Association of HIV infection with the development of severe and complicated malaria cases at a rural hospital in Zimbabwe

OBJECTIVE: To determine the association between HIV infection and progression of Plasmodium falciparum malaria illness in Hurungwe district, Zimbabwe. DESIGN: Prospective cohort. SETTING: Hurungwe Rural Hospital in Mashonaland West Province, Zimbabwe. SUBJECTS: Blood slide positive P. falciparum malaria patients. MAIN OUTCOME MEASURES: Development of severe and complicated malaria. RESULTS: A total of 659 clinical malaria cases were investigated and 237 (36.0%) confirmed cases entered the study. The total HIV positive malaria patients were 82 (34.6%) of confirmed cases or 12.4% of the total clinical cases. The case fatality rate was 5.9% (14 deaths) in the confirmed cases and 11 of these deaths were HIV positive. The commonly reported complications were high parasite count of 2% or more (38.5%), anaemia (29.0%), cerebral malaria (23.1%), low blood pressure (8.3%) and renal failure (1.2%). The HIV positive cases which developed severe and complicated malaria were 72, 30.4% of the sample studied or 55.8% of the total severe and complicated cases. The mode of transport to the nearest health centre was the only confounding factor identified during the analysis. After adjusting for this confounding factor, the risk of developing severe and complicated malaria was 2.35 (95% CI 1.85 to 2.98) times more in the HIV positive malaria patients than in HIV negative patients. CONCLUSION: We conclude that HIV infection is significantly associated with the development of severe and complicated malaria. There is need for future studies to determine whether HIV positive malaria patients require different management protocol from HIV negative malaria patients.