Clinical burden and correlates of HIV and malaria co-infection, in northwest Nigeria

The clinical burden of malaria and HIV/AIDS in sub-Saharan Africa is well-described, but the dynamics of the interaction between the two diseases remain poorly understood. Using a cross-sectional study design, we assessed the prevalence and predictors of malaria infection among HIV-positive patients attending a referral center in urban Kano, northwest Nigeria. Structured questionnaires covering socio-demographic characteristics, HIV diagnosis and treatment, malaria preventive practices, clinical events and treatment were administered to HIV-infected adults (n = 363). Information from questionnaires was supplemented with data from case notes. In the preceding year, nearly a third of respondents (32.2%; 95% CI = 27.4–37.3) had at least one episode of fever, diagnosed as malaria on blood film examination. Half of all respondents (53.5%) admitted to using insecticide treated nets (ITN). One-third (35.8%) of participants were on malaria chemoprophylaxis at the time of the study. Female sex (adjusted Odds Ratio [aOR] = 1.54, 95% confidence interval (CI): 1.32–2.73), immunosuppression (CD4+ cell count <350/μL vs. 600/μL, aOR = 2.41, 95% CI 1.23–3.74) and non-use of ITN (aOR = 1.97, 95% CI 1.17–2.85) predicted the occurrence of clinical malaria in patients. We report a high burden of malaria in HIV-infected patients attending a tertiary facility in urban Kano, Nigeria. Health communication, standardized protocols and ITN distribution should be integrated into comprehensive HIV programs in this setting.