Malaria 'could speed up spread of HIV'

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If we needed more of a kick to integrate our health care systems, here it is!

Malaria 'could speed up spread of HIV'

Levels of the HIV virus in blood can double during malaria infections

Priya Shetty

20 January 2005

Source: SciDev.Net

Health services in developing countries should integrate programmes treating

HIV/AIDS and malaria, say researchers, following publication of a study showing

that having malaria could make people with HIV more likely to transmit the

virus. The study, published last week in The Lancet, showed that levels of the

HIV virus in the blood almost doubled when patients got malaria. Eight to nine

weeks after being treated for malaria, HIV levels returned to what they were at

the start of the study.Even a temporary increase in virus concentration could

increase HIV transmission, warn the researchers, led by Malcolm Molyneux of the

Malawi-Liverpool-Wellcome Trust Clinical Research Programme in Malawi.

Molyneux's team looked at 367 people with HIV in Thyolo District, Malawi. Of

these, 148 developed malaria during the study, but the team was only able to

collect sufficient information for analysis from 77 of these patients.

The researchers suggest that malaria causes HIV levels to increase because the

human body's immune system produces more white blood cells to attack the malaria

parasite. But stimulating the immune system like this activates the HIV virus,

which begins replicating. This increase in viral concentration could, say the

researchers, be sustained long enough to increase risk of HIV transmission.In an

accompanying commentary in The Lancet, Whitworth at the London School of

Hygiene and Tropical Medicine, United Kingdom, and Kirsten Hewitt at the Health

Protection Agency Centre for Infections, also in London, say that because

malaria and HIV affect large numbers of people, even small increases in

transmission of HIV are important, so better integration of health services for

the two diseases is crucial.

They suggest the temporary increase in viral load reported by Molyneux's team

could equate to about a 50 per cent increase in HIV transmission during this

period. Neil French, of the Malawi-Liverpool-Wellcome Trust laboratories, told

SciDev.Net that discovering the exact interaction between malaria and HIV would

be difficult because the research would require treating people under study for

neither disease. Such 'non-intervention' would be unethical given the increasing

availability of HIV and malaria drugs in areas affected by both diseases.French

points out that the two diseases overlap on social as well biological levels.

The poorest in society are most likely to be infected by HIV and least likely to

have access to bednets to prevent malaria. Disease control programmes, he adds,

should come together to provide a comprehensive package of care.

In the developed world, the threat of simultaneous infection with HIV and other

iseases has been reduced by use of antiretroviral drugs. In the developing

world, however, being infected by both malaria and HIV could be more important

because rugs against HIV are not widely available. French suggests that a

pragmatic approach might be to give people with HIV bednets to reduce their

chance of getting malaria.The World Health Organization estimates that together

malaria and HIV cause more than four million deaths per year worldwide.

Link

<http://www.thelancet.com/journal/vol365/iss9455/full/llan.365.9455.primary_

research.31922.1> to paper by Molyneux et al in The Lancet.

Link

<http://www.thelancet.com/journal/vol365/iss9455/full/llan.365.9455.analysis

_and_interpretation.31934.1> to commentary by Whitworth and Hewitt in The

Lancet Reference: The Lancet 365, 233 (2005)

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