Palliative Care for People

Living with HIV/AIDS

Module 7:
Malaria and HIV/AIDS

Learning Objectives
Describe the interactions between
malaria and HIV.
Discuss strategies for preventing
malaria as part of the palliative care
package.
Implement strategies to treat malaria
among people with HIV/AIDS.

Module 7: Malaria and HIV/AIDS

Background
Malaria and HIV/AIDS are both endemic in
Ethiopia:

50 million people are at risk for malaria.

9 million reported cases annually.
Leading cause of morbidity and mortality.
0.93.5% HIV prevalence, 420,000, 1.3 million
with HIV/AIDS

The most vulnerable groups for malaria and

HIV/AIDS are similar: pregnant women,
young children, the poor.
Coordinated service delivery can help
prevention and treatment of both diseases.
Source:
UNICEF; FMOH, 2004; FMOH, 2006; 3
Module 7: Malaria and
HIV/AIDS
UNAIDS, 2007

Impact of HIV/AIDS on Malaria

People with HIV/AIDS are more likely to
have symptomatic malaria, severe malaria,
and anemia.
Prevalence and density of placental and
peripheral parasitemia are higher in HIVinfected pregnant women.
Pregnant women coinfected with HIV and
malaria are at higher risk for anemia,
preterm birth, and low birth weight infants.
Antimalarial treatment failure may be more
common in people with low CD4 counts.
Sources: Francesconi, et al, 2001; French, et al, 2001; Patnak, et al, 2005;
ter Kuile, et al, 2004; Ayisi, et al, 2003

Module 7: Malaria and HIV/AIDS

Impact of Malaria on HIV/AIDS

Long-term data are lacking
Acute malarial episodes cause a
temporary increase in viral replication
Placental malaria may increase viral
load

Sources:
et al, 2005; Whitworth, et al, 2005
Module 7: Malaria
and Kublin,
HIV/AIDS

Module 7: Malaria and HIV/AIDS

Malaria Control and Prevention

Strategies in Ethiopia
Rapid diagnosis and prompt treatment.
Selective vector control:
ITN (Insecticide treated nets).
IRS (indoor residual spray).
Others:
Environmental modification.
Larviciding.

Early detection and containment of malaria epidemic.

Other strategies that work are intermittent
presumptive treatment of pregnant women, pCTX,
HAART.
Focus on children <5 years and pregnant women in
endemic areas.
Module 7: Malaria and HIV/AIDS

Uganda Study
Combination of:
pCTX
ART
Treated nets

Associated with a 95% reduction in the

incidence of symptomatic malaria
among people with HIV/AIDS.

Source: Mermin, et al, 2006

Module 7: Malaria and HIV/AIDS

Insecticide-Treated Nets (ITNs)

In Africa, ITNs have been shown to reduce all
cause mortality by 20%.
ITNs will have a public health impact if >80% of
the population at risk uses them.
Pregnant women and children under five living
in malarial areas are the top priority for ITN.
Application of insecticide (dipping) greatly
enhances the protective efficacy of bed nets.
Long lasting nets are distributed in Ethiopia,
which is advantageous because they dont need
pretreatment.
Module 7: Malaria and HIV/AIDS

Malaria Treatment (1)

Use laboratory tests to diagnose malaria
when possible. The Ethiopian guidelines
recommend:
Health post level: clinical or clinical + RDT
Health center and hospital level: Microscopy
Use laboratory tests in HIV-positive people
whenever possible

HIV/malaria coinfected patients may show

different clinical symptoms.
Look for and treat anemia.
Module 7: Malaria and HIV/AIDS

10

Malaria Treatment (2)

Rapid treatment with artemisinin-based
combination therapy (ACT).
Contraindicated in children <5 kg and
pregnant women.

Module 7: Malaria and HIV/AIDS

11

Unanswered Questions
What is the impact of malaria on MTCT?
What are some interactions between
antimalarial drugs and ARVs?
What is the relationship between pCTX and
malaria?
Note: Preventive therapy for pregnant women on
pCTX not advised by WHO.
What is the role of pCTX in preventing peripheral
and placental malaria?
Module 7: Malaria and HIV/AIDS

12

Key Points
Integration of malaria and HIV prevention and
treatment activities is crucial.
People with HIV/AIDS are more likely to have
symptomatic and severe malaria, and anemia.
Pregnant women and children with HIV/AIDS are
most at risk for malaria.
Education on preventive measures and provision
of ITNs is part of the HIV care package.
The use of ITNs, pCTX, and ART can greatly
reduce malaria incidence in people with HIV.
Watch for interactions of ACT and ARVs.
Module 7: Malaria and HIV/AIDS

13

Module 7 Wrap-Up

Module 7: Malaria and HIV/AIDS

14