CD4 T-cell count and HIV-1 infection in adults with uncomplicated malaria

Background: HIV-1 negative children with malaria have reversible lymphocyte and CD4 count decreases. We assessed the impact of malaria parasitemia on the absolute CD4 count in both HIV-1-infected and non-HIV-infected adults. Methods: In Ndola, Zambia, at the health-center level, we treated 327 nonpregnant adults for confirmed, uncomplicated, clinical malaria. We assessed HIV-1 status, CD4 count, and HIV-1 viral load (if HIV-1 infected) at enrollment and at 28 and 45 days after treatment. Results: After successful antimalarial treatment, the median CD4 count at day 28 of follow-up increased from 468 to 811 cells/P.L in HIV-1-negative and from 297 to 447 cells/RL in HIV-1-positive patients (paired t test, P < 0.001 for both). CD4 count increment was inversely correlated with CD4 count at day 0 in both HIV-1 negative (P < 0.001) and HIV-1-positive patients (P < 0.03). After successful treatment, the proportion of patients with CD4 count < 200/mu L at day 45 decreased from 9.6% to 0% in HIV-1-negative and from 28.7% to 13.2% in HIV-1-positive malaria patients (P < 0.001 for both). In patients with detectable but mostly asymptomatic parasiternia, CD4 count and, if HIV-1-infected, viral load at day 45 of follow-up were similar to those observed at enrollment. Conclusion: Interpretation of absolute CD4 count might be biased during orjust after a clinical inalaria episode. Therefore, in malariaendemic areas, before taking any decision on the management of HIV-1-positive individuals, their malaria status should be assessed.