ABSTRACT
BACKGROUND: Despite public health significance of dual infections of human immunodeficiency virus (HIV) and malaria in developing countries like Nigeria, information on the association between malaria parasite density count (MPDC) and hematological parameter changes among HIV-infected individuals is rarely available. OBJECTIVES: To evaluate burden of HIV and malaria dual infections and assess the predictive association of MPDC with hematological parameter changes among HIV infected adults attending two antiretroviral treatment clinics in Kano, Nigeria. Methodology. This was a cross-sectional study consisting of 1521 consented participants randomly selected between June 2015 and May 2016. Participants' basic characteristics and clinical details were collected using a pretested and validated standardized questionnaire. Collected venous blood was analyzed for malaria by rapid testing and microscopy including malaria parasite density; hematological parameters were estimated using a Sysmex XP-300 autoanalyzer. Data was reviewed, cleaned, and analyzed using SPSS software version 23.0. Mean hematological parameters and HIV/malaria status were compared using the independent t-test; hematological parameters and MPDC relationship was tested by simple linear regression analysis. Statistically significant difference at probability of <0.05 was considered for all variables. RESULTS: The majority (70.6%) of the participants were females. Mean (SD) age was 37.30 ± (10.41) years and ranged from 18 to 78 years. 25.4% of participants had dual infection, 99% due to Plasmodium falciparum species. Mean MPDC was 265 ± 31.8 (SD) cells/µl and ranged from 20 to 2500 cells/µl. Dual infection was highest (37.5%) among respondents in the age group ≥60 years. Prevalence was similar among other age groups (p = 0.165) and gender (p = 0.942). Of the 16 hematological parameters evaluated, 11 showed significant difference between HIV mono-infected and dual infected participants. Of the 11 parameters, only 7 (Hb, MCHC, red cells count, neutrophil and lymphocyte percentage, absolute lymphocyte count, and red cell distribution width) were significantly predictive of changes with respect to MPDC. CONCLUSIONS: MPDC was significantly predictive of changes in 7 hematological parameters among dual infected participants in these settings. In routine malaria diagnosis, MPDC determination with respect to changes in some hematological parameters should be considered in ART programs for improved patient management.
ABSTRACT
BACKGROUND: Malaria diagnosis among HIV-positive patients is uncommon in Nigeria despite the high burden of both diseases. OBJECTIVES: We evaluated the performance of a malaria rapid diagnostic test (MRDT) against blood smear microscopy (BSM) among HIV-positive patients in relation to anti-retroviral treatment (ART) status, CD4+ count, fever, cotrimoxazole prophylaxis and malaria density count. METHOD: A cross-sectional study involving 1521 consenting randomly selected HIV-positive adults attending two ART clinics in Kano, Nigeria, between June 2015 and May 2016. Venous blood samples were collected for testing with MRDT, BSM, and CD4+ T cells count by cytometry. Biodata and other clinical details were extracted from patient folders into an Excel file, cleaned, validated, and exported for analysis into SPSS version 23.0. Sensitivity, specificity, predictive values of MRDT were compared with BSM with a 95% confidence interval. RESULTS: Malaria parasites were detected in 25.4% of enrollees by BSM and 16.4% by MRDT. Overall sensitivity of MRDT was 58% and specificity was 97%. Cotrimoxazole prophylaxis and fever status did not affect MRDT sensitivity and specificity. Unexpectedly, the sensitivity was highest at parasite density count of less than 500 cells/µL. At CD4+ T cells count over 500 cells/µL the sensitivity was higher (62.4%) compared to 56% at less than 500 cells/µL. In the non-ART group sensitivity was higher (65%) compared to those on ART (56%) but the specificity was similar. All differences were significant for all variables (p < 0.05). CONCLUSION: Although the MRDT specificity was good, the sensitivity was poor, requiring further evaluation for use in malaria diagnosis among HIV-malaria co-infected persons in these settings.
