Implications of asymptomatic malaria infections on hematological parameters in adults living with HIV in malaria endemic regions with varying transmission intensities.

OBJECTIVES: HIV and malaria coinfection impacts disease management and clinical outcomes. This study investigated hematological abnormalities in malaria asymptomatic people living with HIV (PLHIV) in regions with differing malaria transmission.

METHODS: Study participants were enrolled in the African Cohort Study: two sites in Kenya, one in Uganda and one in Nigeria. Data was collected at enrollment and every six months. Logistic regression estimated odds ratios for associations between HIV/malaria-status and anemia, thrombocytopenia, and leucopenia.

FINDINGS: Samples from 1587 participants with one or more visits comprising 1471 (92.7%) from PLHIV and 116 (7.3%) without HIV were analyzed. Parasite point prevalence significantly differed across the study sites (p<0.001). PLHIV had higher odds of anemia, with males at lower odds compared to females; the odds of anemia decreased with age, reaching significance in those ≥50 years-old. Participants in Kisumu, Kenya had higher odds of anemia compared to other sites. PLHIV had higher odds of leucopenia, but malaria co-infection did not associate with worsened leucopenia. The odds of thrombocytopenia were decreased in HIV/malaria coinfection compared to the uninfected group.

INTERPRETATION: Hematological parameters are important indicators of health and disease. In PLHIV with asymptomatic malaria coinfection enrolled across four geographic sites in three African countries, abnormalities in hematologic parameters differ in different malaria transmission settings and are region specific.