Malaria Co-Infection and the Oral Manifestations of HIV-Infection

1Faculty of Dentistry, Obafemi Awolowo University (OAU) Ile-Ife, Nigeria. 2Medical Microbiology and Parasitology Department, OAU, Ile-Ife, Nigeria. 3Department of Pediatrics, OAU, Ile-Ife, Nigeria. 4Department of Orofacial Sciences, University of California, San Francisco, USA

Objectives: Malaria and HIV-infection frequently overlap and are predominant sources of morbidity and mortality in Sub-Saharan Africa. The concurrent existence of both conditions has important implications with regard to the diagnosis, staging and management of HIV infection. Efforts are underway to define the best practices for the diagnosis, prevention and management of HIV-malaria co-infection. This study is aimed at investigating the role of malaria on the diagnosis and management of oral lesions seen in HIV infection.

Methods: A cross sectional study of eighty-five subjects attending the HIV clinic of a tertiary referral center. Demographic data, CD4 count (/µl), malaria parasite count (/µl), packed cell volume and the presence of tuberculosis were recorded. Oral lesions were recorded by staff trained to recognize and document the lesions.

Results: Oral lesions associated with HIV infection (Oral/oropharyngeal candidiasis, salivary gland enlargement, hairy leukoplakia and linear gingival erythema) were observed in 35 (39.8%) subjects. The median malaria parasite count and interquartile range (IQR) in subjects with oral lesions, 2200 (800 - 3,400) was not statistically different from those without, 2200 (1160 - 3800). The median CD4 count was lower in subjects with oral lesions,146.5 (IQR, 78.5 - 331.5) than in subjects without, 240, (IQR 124 – 364). This difference was not statistically significant. A significant interaction was found between CD4 count dichotomized at 200 and malaria parasite count, p= 0.021

Conclusion: Malaria parasite count did not influence presence of oral lesions in HIV-infection despite a significant interaction between malaria parasite count and CD4 count. Larger studies and those separating children from adults are needed to further clarify the effect of malaria on the oral lesions seen in HIV infection.