Abstract

Severe malaria and HIV coinfection is a disastrous syndemism especially in the face of antimalarial resistance and pregnancy. This case-control study investigated the effects of severe malaria parasitaemia (SMP)/HIV coinfections on hemoglobin concentration and CD4+ cell counts of pregnant women attending four government-owned secondary hospitals in Kaduna State, Nigeria. Eighteen HIV-infected women with SMP served as test subjects while 23 HIV-uninfected women with SMP served as control subjects. All test subjects were on firstline antiretroviral therapy. Antimalarial susceptibility testing (using chloroquine, artesunate, artether and sulfadoxin-pyrimethamine), CD4+ cell counts and hemoglobin concentration were conducted using schizont maturation assay, flow cytometry and methemoglobin methods respectively. Multidrug-resistant severe malaria parasitemia (MDRSMP) was defined by resistance against three or more antimalarial drugs. Eight (44.4%) women with SMP/HIV coinfections and none of the control subjects had MDRSMP respectively. There was statistical association between MDRSMP in test and control subjects (P = 0.015). Women with SMP had significantly low hemoglobin concentration [(7.1 ± 1.8) g/dL] and low CD4+ cell counts [(209.0 ± 43.0) cells/mm3] when compared with the control counterparts [(10.8 ± 2.2) g/dL and (431.0 ± 57.4) cells/mm3] (P < 0.05). SMP/HIV coinfection was significantly correlated with hemoglobin concentration (r = –1.25, P = 0.03) but not with CD4+ cell counts (r = –2.44, P = 0.075). SMP/HIV coinfections exist in our study area. In the absence of appropriate and prompt clinical interventions, these may lead to severe anemia and CD4+ lymphopenia.

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