BackgroundHuman immunodeficiency virus (HIV)–1 infected adults with low CD4 cell count have a higher risk of malaria infection and clinical malaria. We assessed the influence that HIV-1 immune suppression has on the efficacy of antimalarial treatment in adults with uncomplicated malaria

MethodsThis clinical trial included 971 Zambian adults with uncomplicated malaria. Patients were tested for HIV-1, and, if positive, a CD4 cell count was assessed. The primary outcome was recurrent parasitemia corrected by molecular genotyping within 45 days after treatment

ResultsHIV-1 infection was detected in 33% (320/971) of adult patients with malaria. Treatment failure was not associated with HIV-1 infection (relative risk [RR], 1.12 [95% confidence interval {CI}, 0.82–1.53]; P=.45). HIV-1–infected patients with a CD4 cell count <300 cells/μL had an increased risk of recurrent parasitemia, compared with those with a CD4 cell count ⩾300 cells/μL (RR, 2.24 [95% CI, 1.20–4.14]; P=.01). After genotyping, the risk of recrudescence was higher in HIV-1–infected patients with a CD4 cell count <300 cells/μL than in the other patients with malaria (RR, 1.67 [95% CI, 1.13–2.47]; P=.02)

ConclusionHIV-1–infected patients with malaria with a CD4 cell count <300 cells/μL have a higher risk of experiencing a recrudescent infection, compared with those with a CD4 cell count ⩾300 cells/μL or without HIV-1 infection

Trial registered at http://www.clinicaltrials.gov/; reference number NCT00304980