Severe malaria parasitaemia and its effects on hemoglobin and CD4+ cells of HIV infected pregnant women at Kaduna State, Nigeria

Severe malaria and HIV coinfection is a disastrous syndemism especially in the face of\udantimalarial resistance and pregnancy. This case-control study investigated the effects of\udsevere malaria parasitaemia (SMP)/HIV coinfections on hemoglobin concentration and CD4+\udcell counts of pregnant women attending four government-owned secondary hospitals in\udKaduna State, Nigeria. Eighteen HIV-infected women with SMP served as test subjects while\ud23 HIV-uninfected women with SMP served as control subjects. All test subjects were on firstline antiretroviral therapy. Antimalarial susceptibility testing (using chloroquine, artesunate,\udartether and sulfadoxin-pyrimethamine), CD4+ cell counts and hemoglobin concentration were\udconducted using schizont maturation assay, flow cytometry and methemoglobin methods\udrespectively. Multidrug-resistant severe malaria parasitemia (MDRSMP) was defined by\udresistance against three or more antimalarial drugs. Eight (44.4%) women with SMP/HIV\udcoinfections and none of the control subjects had MDRSMP respectively. There was statistical\udassociation between MDRSMP in test and control subjects (P = 0.015). Women with SMP had\udsignificantly low hemoglobin concentration [(7.1 ± 1.8) g/dL] and low CD4+ cell counts [(209.0\ud± 43.0) cells/mm3] when compared with the control counterparts [(10.8 ± 2.2) g/dL and (431.0 ±\ud57.4) cells/mm3] (P < 0.05). SMP/HIV coinfection was significantly correlated with hemoglobin\udconcentration (r = –1.25, P = 0.03) but not with CD4+ cell counts (r = –2.44, P = 0.075). SMP/HIV\udcoinfections exist in our study area. In the absence of appropriate and prompt clinical interventions,\udthese may lead to severe anemia and CD4+ lymphopenia