Interaction of malaria and HIV in Africa

doi:10.1136/bmj.b2141

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Richard Reithinger, honorary lecturer1,
Moses R Kamya, professor2,
Christopher JM Whitty, professor3,
Grant Dorsey, associate professor4,
Sten H Vermund, director of the institute and professor of pediatrics5

¹London School of Hygiene and Tropical Medicine, London
²Medical School, Makerere University, Kampala, Uganda
³Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
⁴Department of Medicine, University of California San Francisco, California, USA
⁵Institute for Global Health and Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Correspondence to: R Reithinger rreithinger{at}yahoo.co.uk

Is well known at a biological and health systems level, but often ignored

Malaria and HIV/AIDS are two of the most important infectious diseases worldwide, accounting for almost 9% of the total burden of disease in sub-Saharan Africa.1 There is good evidence of a biological interaction between them, but their combined impact on health systems is even more substantial, especially in Africa. This is often ignored.

Evidence for a biological interaction in people who are co-infected has grown. Until 1998 there was “no convincing evidence for an interaction between malaria and HIV.”2 By 2006 it was estimated that the interaction of malaria and HIV in one Kenyan district alone had caused 980 000 excess malaria episodes and 8 500 excess HIV infections since HIV’s emergence in the 1980s.3 Malaria is more common and severe in adults with HIV, pregnant women, and children.4 HIV viral load is greater in women with placental malaria, and infants born to women with both HIV and placental malaria are of …