An association between HIV-1 and malaria is expected in theory; but has not been convincingly shown in practice. We studied the effects of HIV-1 infection and advancing immunosuppression on falciparum parasitaemia and clinical malaria.

Methods:

HIV-positive and HIV-negative adults selected from a population-based cohort in rural Uganda were invited to attend a clinic every 3 months (routine visits) and whenever they were sick (interim visits). At each visit; information was collected on recent fever; body temperature; and malaria parasites. Participants were assigned a clinical stage at each routine visit and had regular CD4-cell measurements.

Findings:

484 participants made 7220 routine clinic visits between 1990 and 1998. Parasitaemia was more common at visits by HIV-1-positive individuals (328 of 2788) [11.8] vs 231 of 3688 [6.3]; p0.0001). At HIV-1-positive visits; lower CD4-cell counts were associated with higher parasite densities; compared with HIV-1-negative visits (p