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Double Epidemic

By Rebecca Palmer

2007 Article Links

Benefits of ASM Membership
Challenges of Writing
Double Epidemic
Fifth Disease
Fish With Hormonal Imbalances
Frankel Photos
Frankel Talk
Hep C Meds
Horror of AIDS
Hantavirus in New Mexico
Juan Reyna
Nature or Nurture
Nosocomial Infections are a Red Flag
Open Eyes to Science
Pandemic Flu Plans
Polio
Project ECHO
Typhoid Mary
West Nile Prevention
Zoo Diseases

Sub-Saharan Africa, home to more than 29 million people living with HIV/AIDS, is endemic to malaria.  Combined, these two diseases result in more than four million deaths a year and are the leading cause of death for children and pregnant women.  As a consequence of the low birth rate and the high child mortality rate, this region of Africa will suffer the effects of an almost absent generation.

Deadly combination
               
Malaria and HIV/AIDS are two diseases that overrun impoverished areas and families that earn around $60/year cannot afford medication and prophylaxis for one disease, much less two, or for all members of the family.  Both diseases are deadly and endemic, but it does not seem to be widely known that they each contribute to a person’s vulnerability of the other, and that treatment of one disease and not the other is counterproductive. 

The combination of these diseases has major public health implications.  As reported by the World Health Organization in 2004, men, women, and children with HIV/AIDS are more susceptible to malaria because of advanced immunosuppression and if contracted, malaria cases may be more severe and unresponsive to drug treatment.  Again, if HIV/AIDS is already present, an acute case of malaria could temporarily increase viral replication, therefore increasing HIV viral load and boosting malaria parasite density. 

Risks for pregnant women               

For the 10.5 million pregnant women who develop malaria every year, the outlook is grim.  HIV infected pregnant women are more likely to develop malaria than those who are not infected.

As HIV prevalence increases, the number of malaria cases during pregnancy attributable to HIV also increases.  The WHO’s study, “Malaria and HIV interactions and their implications for public health policy,” reports that in 2003, 440,000 cases of malaria in pregnant women were attributable to the HIV epidemic in Africa.  Also, with the increased rate of malaria in pregnant women, there is an increased rate of placental malaria which causes low-birth weight, spontaneous abortion, or neo-natal death.  Studies are so far inconclusive as to if having malaria increases the risk of mother-to-child-transmission of HIV. 

Treatment
               
Many of the drugs used to treat HIV and malaria have adverse reactions when combined.  As reported by WHO, one drug, cotrimoxazole has been shown to decrease malaria morbidity in the general HIV-infected population, but it is unknown whether it is effective in preventing malaria in pregnant women.  The most effective solution to date is insecticide-treated tents which have reduced the prevalence of malaria among pregnant women.  Every year 1-3 million people die from malaria, 90% of whom live in sub-Saharan Africa so a vaccine is important not only to this large population of people, but also the HIV/AIDS sufferers who have an increased chance of contracting malaria. 
               
To eradicate HIV/AIDS from central Africa, an important first step is to draw up a plan of action against malaria.  Malaria hinders any efforts to stall the spread of HIV so it makes sense to first contain the spread of malaria, as a means of preventing further complications with HIV.