1
|
Obeagu EI, Obeagu GU, Ubosi NI, Uzoma IC, Tayrab EMA. Concurrent management of HIV and malaria: A comprehensive review of strategies to enhance quality of life. Medicine (Baltimore) 2024; 103:e37649. [PMID: 38579091 PMCID: PMC10994515 DOI: 10.1097/md.0000000000037649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/27/2024] [Indexed: 04/07/2024] Open
Abstract
The co-occurrence of human immunodeficiency virus and malaria presents a complex medical scenario, significantly impacting the quality of life for affected individuals. This comprehensive review synthesizes current knowledge, challenges, and strategies concerning the concurrent management of these infections to improve overall well-being. Epidemiological insights reveal the prevalence and demographic trends, highlighting geographical areas of concern and socioeconomic factors contributing to the burden of co-infection. Pathophysiological interactions elucidate the compounding effects, altering disease progression and treatment outcomes. Healthcare challenges underscore the necessity for integrated care models, evaluating existing healthcare frameworks and their efficacy in addressing dual infections. In-depth analysis of interventions explores pharmacological, behavioral, and preventive measures, evaluating their efficacy and safety in co-infected individuals. Additionally, the review assesses psychosocial support mechanisms, emphasizing community-based interventions and peer networks in enhancing holistic care. Consideration is given to the role of antiretroviral therapy, malaria prevention strategies, and the evolving landscape of healthcare delivery in optimizing outcomes for this vulnerable population. The paper concludes by emphasizing the significance of multidisciplinary approaches and integrated care models, stressing the need for continued research and collaborative efforts to advance interventions and improve the quality of life for those navigating the complexities of human immunodeficiency virus and malaria co-infection.
Collapse
Affiliation(s)
| | | | - Nwanganga Ihuoma Ubosi
- Department of Medical Laboratory Science, Kampala International University, Kampala, Uganda
- Department of Public Health Sciences, Faculty of Health Sciences, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Ijeoma Chinwe Uzoma
- Molecular-Hematology and Immuno Genetics Unit, Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Eltayeb Mohamed Ahmed Tayrab
- Chemical Pathology, Department of Pathology, Faculty of Medicine and Dentistry, Kampala International University, Kampala, Uganda
| |
Collapse
|
2
|
Figueroa-Romero A, Saura-Lázaro A, Fernández-Luis S, González R. Uncovering HIV and malaria interactions: the latest evidence and knowledge gaps. Lancet HIV 2024:S2352-3018(24)00035-3. [PMID: 38458223 DOI: 10.1016/s2352-3018(24)00035-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/12/2024] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
The geographical distribution of malaria and HIV infections widely overlap in sub-Saharan Africa, constituting a complex global health challenge. The interplay between both infections raises concerns about potential immunological, clinical, and therapeutic interactions. Both diseases have been reported to exacerbate the transmission of the other, including the possible vertical transmission of HIV in pregnant individuals with malaria. Co-infection also increases the risk of adverse outcomes such as severe malaria and death. In addition, interactions between antiretroviral and antimalarial drugs have been reported, potentially reducing the efficacy of these drugs. We review the current knowledge of the epidemiological, clinical, immunological, and therapeutic interactions of both infections. We focus on the latest available data and identify key knowledge gaps that should be addressed to guide policy makers in providing optimal HIV and malaria prevention, care, and treatment in vulnerable populations.
Collapse
Affiliation(s)
- Antía Figueroa-Romero
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Saura-Lázaro
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Sheila Fernández-Luis
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Pediatrics Department, Pediatric Research and Clinical Trials Unit (UPIC), Fundación para la Investigación Biomédica del Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (IMAS12), Madrid, Spain
| | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
| |
Collapse
|
3
|
Long B, MacDonald A, Liang SY, Brady WJ, Koyfman A, Gottlieb M, Chavez S. Malaria: A focused review for the emergency medicine clinician. Am J Emerg Med 2024; 77:7-16. [PMID: 38096639 DOI: 10.1016/j.ajem.2023.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Malaria is a potentially fatal parasitic disease transmitted by the Anopheles mosquito. A resurgence in locally acquired infections has been reported in the U.S. OBJECTIVE This narrative review provides a focused overview of malaria for the emergency clinician, including the epidemiology, presentation, diagnosis, and management of the disease. DISCUSSION Malaria is caused by Plasmodium and is transmitted by the Anopheles mosquito. Disease severity can range from mild to severe. Malaria should be considered in any returning traveler from an endemic region, as well as those with unexplained cyclical, paroxysms of symptoms or unexplained fever. Patients most commonly present with fever and rigors but may also experience cough, myalgias, abdominal pain, fatigue, vomiting, and diarrhea. Hepatomegaly, splenomegaly, pallor, and jaundice are findings associated with malaria. Although less common, severe malaria is precipitated by microvascular obstruction with complications of anemia, acidosis, hypoglycemia, multiorgan failure, and cerebral malaria. Peripheral blood smears remain the gold standard for diagnosis, but rapid diagnostic tests are available. Treatment includes specialist consultation and antimalarial drugs tailored depending on chloroquine resistance, geographic region of travel, and patient comorbidities. Supportive care may be required, and patients with severe malaria will require resuscitation. Most patients will require admission for treatment and further monitoring. CONCLUSION Emergency medicine clinicians should be aware of the presentation, diagnosis, evaluation, and management of malaria to ensure optimal outcomes.
Collapse
Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| | - Austin MacDonald
- Department of Emergency Medicine, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, USA.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, USA.
| |
Collapse
|
4
|
Takyi A, Carrara VI, Dahal P, Przybylska M, Harriss E, Insaidoo G, Barnes KI, Guerin PJ, Stepniewska K. Characterisation of populations at risk of sub-optimal dosing of artemisinin-based combination therapy in Africa. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002059. [PMID: 38039291 PMCID: PMC10691722 DOI: 10.1371/journal.pgph.0002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/25/2023] [Indexed: 12/03/2023]
Abstract
Selection of resistant malaria strains occurs when parasites are exposed to inadequate antimalarial drug concentrations. The proportion of uncomplicated falciparum malaria patients at risk of being sub-optimally dosed with the current World Health Organization (WHO) recommended artemisinin-based combination therapies (ACTs) is unknown. This study aims to estimate this proportion and the excess number of treatment failures (recrudescences) associated with sub-optimal dosing in Sub-Saharan Africa. Sub-populations at risk of sub-optimal dosing include wasted children <5 years of age, patients with hyperparasitaemia, pregnant women, people living with HIV, and overweight adults. Country-level data on population structure were extracted from openly accessible data sources. Pooled adjusted Hazard Ratios for PCR-confirmed recrudescence were estimated for each risk group from published meta-analyses using fixed-effect meta-analysis. In 2020, of the estimated 153.1 million uncomplicated P. falciparum malaria patients in Africa, the largest risk groups were the hyperparasitaemic patients (13.2 million, 8.6% of uncomplicated malaria cases) and overweight adults (10.3 million, 6.7% of uncomplicated cases). The estimated excess total number of treatment failures ranged from 0.338 million for a 98% baseline ACT efficacy to 1.352 million for a 92% baseline ACT efficacy. Our study shows that an estimated nearly 1 in 4 people with uncomplicated confirmed P. falciparum malaria in Africa are at risk of receiving a sub-optimal antimalarial drug dosing. This increases the risk of antimalarial drug resistance and poses a serious threat to malaria control and elimination efforts. Changes in antimalarial dosing or treatment duration of current antimalarials may be needed and new antimalarials development should ensure sufficient drug concentration levels in these sub-populations that carry a high malaria burden.
Collapse
Affiliation(s)
- Abena Takyi
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Verena I. Carrara
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Prabin Dahal
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
| | | | - Eli Harriss
- The Knowledge Centre, Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | | | - Karen I. Barnes
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Philippe J. Guerin
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
| | - Kasia Stepniewska
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Infectious Diseases Data Observatory (IDDO), Oxford, United Kingdom
- WorldWide Antimalarial Resistance Network (WWARN), Oxford, United Kingdom
| |
Collapse
|
5
|
Oyieko J, Copeland NK, Otieno S, Kifude C, Ocholla S, Hutter J, Smith H, Roberds A, Luckhart S, Stewart VA. Longitudinal and Cross-sectional Analyses of Asymptomatic HIV-1/Malaria Co-infection in Kisumu County, Kenya. Am J Trop Med Hyg 2023; 108:85-92. [PMID: 36410321 PMCID: PMC9833063 DOI: 10.4269/ajtmh.22-0035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals infected with HIV-1 experience more frequent and more severe episodes of malaria and are likely to harbor asymptomatic parasitemia, thus potentially making them more efficient reservoirs of malaria. Two studies (cross-sectional and longitudinal) were designed in sequence between 2015-2018 and 2018-2020, respectively, to test the hypothesis that HIV-1 infected individuals have higher prevalence of asymptomatic parasitemia and gametocytemia than the HIV-1 negatives. This article describes the overall design of the two studies, encompassing data for the longitudinal study and additional data to the previously published baseline data for the cross-sectional study. In the cross-sectional study, HIV-1 positive participants were significantly older, more likely to be male, and more likely to have parasitemia relative to HIV-1 negatives (P < 0.01). In the longitudinal study, 300 participants were followed for 6 months. Of these, 102 were HIV-1 negative, 106 were newly diagnosed HIV-1 positive, and 92 were HIV-1 positive and on antiretroviral therapy, including antifolates, at enrollment. Overall parasitemia positivity at enrollment was 17.3% (52/300). Of these, 44% (23/52) were HIV-1 negative, 52% (27/52) were newly diagnosed HIV-1 positives, and only 4% (2/52) were HIV-1 positive and on treatment. Parasitemia for those on stable antiretroviral therapy was significantly lower (hazard ratio: 0.51, P < 0.001), compared with the HIV-1-negatives. On follow-up, there was a significant decline in parasitemia prevalence (hazard ratio: 0.74, P < 0.001) among the HIV patients newly initiated on antiretroviral therapy including trimethoprim-sulfamethoxasole. These data highlight the impact of HIV-1 and HIV treatment on asymptomatic parasitemia over time.
Collapse
Affiliation(s)
- Janet Oyieko
- Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya
| | | | - Solomon Otieno
- Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya
| | - Carolyne Kifude
- Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya
| | - Stephen Ocholla
- Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya
| | - Jack Hutter
- Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya
| | - Hunter Smith
- Kombewa Clinical Research Center, Kenya Medical Research Institute–U.S. Army Medical Research Directorate—Africa, Kisumu, Kenya
| | - Ashleigh Roberds
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shirley Luckhart
- Department of Entomology, Plant Pathology and Nematology, University of Idaho, Moscow, Idaho
- Department of Biological Sciences, University of Idaho, Moscow, Idaho
| | - V. Ann Stewart
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
6
|
Roberds A, Kifude C, Oyieko J, Ocholla S, Mutunga J, Oullo D, Waga C, Li Z, Luckhart S, Stewart VA. Longitudinal impact of asymptomatic malaria/HIV-1 co-infection on Plasmodium falciparum gametocyte transcript expression and transmission to Anopheles mosquitoes. Front Cell Infect Microbiol 2022; 12:934641. [PMID: 36189366 PMCID: PMC9523792 DOI: 10.3389/fcimb.2022.934641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Despite significant developments towards malaria reduction, parasite transmission in the common context of HIV-1 co-infection and treatment for one or both infections has not been fully characterized. This is particularly important given that HIV-1 and malaria chemotherapies have the potential to alter gametocyte burden and mosquito infectivity. In this study, we examined 782 blood samples collected from a longitudinal cohort of 300 volunteers with asymptomatic parasitemia seeking HIV testing or treatment in the endemic region of Kisumu, Kenya, to define the impacts of HIV-1-malaria co-infection, antiretroviral therapy (ART) plus trimethoprim-sulfamethoxazole (TS) and the antimalarials artemether/lumefantrine (AL) on Plasmodium falciparum gametocyte transcript prevalence and parasite transmission to the African malaria mosquito Anopheles gambiae. Volunteers were assigned to three distinct HIV-1 groups: HIV-1 positive on treatment, HIV-1 positive newly diagnosed, and HIV-1 negative. Volunteers were monitored monthly over the course of six months. Using our highly sensitive digital droplet PCR (ddPCR) assay of three gametocyte specific transcript markers, we detected gametocyte transcripts in 51.1% of 18S positive volunteers across all study groups and time points. After correcting for multiple comparisons, the factors of HIV-1 status, time, CD4+ T-cell levels and hematocrit were not predictive of gametocyte prevalence or transmission. However, among those volunteers who were newly diagnosed with HIV-1 and malaria positive by rapid diagnostic test (RDT) at enrollment, the initiation of ART/TS and AL treatment was associated with a significant reduction in gametocyte transcript prevalence in the subsequent month when compared to HIV-1 negative volunteers treated with AL. To assess gametocyte transmissibility, volunteer blood samples were used in standard membrane feeding assays (SFMA) with laboratory-reared A. gambiae, with evidence of transmission confirmed by at least one of 25 dissected mosquitoes per sample positive for at least one midgut oocyst. HIV-1 status, CD4+ T-cell levels and hematocrit were not significantly associated with successful transmission to A. gambiae. Analysis of SMFA blood samples revealed that 50% of transmission-positive blood samples failed to test positive by Plasmodium-specific 18S ribosomal RNA quantitative PCR (qPCR) and 35% failed to test positive for any gametocyte specific transcript marker by droplet digital (ddPCR), documenting that transmission occurred in the absence of molecular parasite/gametocyte detection. Overall, these findings highlight the complexity of HIV-1 malaria co-infection and the need to further define the unpredictable role of asymptomatic parasitemia in transmission to mosquitoes.
Collapse
Affiliation(s)
- Ashleigh Roberds
- Department of Preventive Medicine and Biostatistics, Division of Global Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
- *Correspondence: Ashleigh Roberds,
| | - Carolyne Kifude
- Kombewa Clinical Research Center, Kenya Medical Research Institute - United States Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - Janet Oyieko
- Kombewa Clinical Research Center, Kenya Medical Research Institute - United States Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - Stephen Ocholla
- Kombewa Clinical Research Center, Kenya Medical Research Institute - United States Army Medical Research Directorate - Africa, Kisumu, Kenya
| | - James Mutunga
- Department of Entomology and Vector Biology, United States Army Medical Research Directorate - Africa/Kenya Medical Research Institute, Kisumu, Kenya
- Department of Biological Sciences, Mount Kenya University, Thika, Kenya
| | - David Oullo
- Department of Entomology and Vector Biology, United States Army Medical Research Directorate - Africa/Kenya Medical Research Institute, Kisumu, Kenya
| | - Charles Waga
- Department of Entomology and Vector Biology, United States Army Medical Research Directorate - Africa/Kenya Medical Research Institute, Kisumu, Kenya
| | - Zhaozhang Li
- Biomedical Instrumentation Center, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Shirley Luckhart
- Department of Entomology, Plant Pathology and Nematology and Department of Biological Sciences, University of Idaho, Moscow, ID, United States
| | - V. Ann Stewart
- Department of Preventive Medicine and Biostatistics, Division of Global Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| |
Collapse
|
7
|
Walsh D, Katris NJ, Sheiner L, Botté CY. Toxoplasma metabolic flexibility in different growth conditions. Trends Parasitol 2022; 38:775-790. [PMID: 35718642 PMCID: PMC10506913 DOI: 10.1016/j.pt.2022.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
Apicomplexan parasites have complex metabolic networks that coordinate acquisition of metabolites by de novo synthesis and by scavenging from the host. Toxoplasma gondii has a wide host range and may rely on the flexibility of this metabolic network. Currently, the literature categorizes genes as essential or dispensable according to their dispensability for parasite survival under nutrient-replete in vitro conditions. However, recent studies revealed correlations between medium composition and gene essentiality. Therefore, nutrient availability in the host environment likely determines the requirement of metabolic pathways, which may redefine priorities for drug target identification in a clinical setting. Here we review the recent work characterizing some of the major Toxoplasma metabolic pathways and their functional adaptation to host nutrient content.
Collapse
Affiliation(s)
- Daniel Walsh
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK
| | - Nicholas J Katris
- ApicoLipid Team, Institute for Advanced Biosciences, CNRS UMR5309, Université Grenoble Alpes, INSERM U1209, Grenoble, France
| | - Lilach Sheiner
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Glasgow, UK.
| | - Cyrille Y Botté
- ApicoLipid Team, Institute for Advanced Biosciences, CNRS UMR5309, Université Grenoble Alpes, INSERM U1209, Grenoble, France.
| |
Collapse
|
8
|
Dias MHF, Guimarães LFF, Barcelos MG, Moreira EUM, do Nascimento MFA, de Souza TN, Pires CV, Monteiro TAF, Middeldorp JM, Soares IS, Fontes CJF, Ntumngia FB, Adams JH, Kano FS, Carvalho LH. Impact of Epstein-Barr virus co-infection on natural acquired Plasmodium vivax antibody response. PLoS Negl Trop Dis 2022; 16:e0010305. [PMID: 35921373 PMCID: PMC9377613 DOI: 10.1371/journal.pntd.0010305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/15/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The simultaneous infection of Plasmodium falciparum and Epstein-Barr virus (EBV) could promote the development of the aggressive endemic Burkitt’s Lymphoma (eBL) in children living in P. falciparum holoendemic areas. While it is well-established that eBL is not related to other human malaria parasites, the impact of EBV infection on the generation of human malaria immunity remains largely unexplored. Considering that this highly prevalent herpesvirus establishes a lifelong persistent infection on B-cells with possible influence on malaria immunity, we hypothesized that EBV co-infection could have impact on the naturally acquired antibody responses to P. vivax, the most widespread human malaria parasite.
Methodology/Principal findings
The study design involved three cross-sectional surveys at six-month intervals (baseline, 6 and 12 months) among long-term P. vivax exposed individuals living in the Amazon rainforest. The approach focused on a group of malaria-exposed individuals whose EBV-DNA (amplification of balf-5 gene) was persistently detected in the peripheral blood (PersVDNA, n = 27), and an age-matched malaria-exposed group whose EBV-DNA could never be detected during the follow-up (NegVDNA, n = 29). During the follow-up period, the serological detection of EBV antibodies to lytic/ latent viral antigens showed that IgG antibodies to viral capsid antigen (VCA-p18) were significantly different between groups (PersVDNA > NegVDNA). A panel of blood-stage P. vivax antigens covering a wide range of immunogenicity confirmed that in general PersVDNA group showed low levels of antibodies as compared with NegVDNA. Interestingly, more significant differences were observed to a novel DBPII immunogen, named DEKnull-2, which has been associated with long-term neutralizing antibody response. Differences between groups were less pronounced with blood-stage antigens (such as MSP1-19) whose levels can fluctuate according to malaria transmission.
Conclusions/Significance
In a proof-of-concept study we provide evidence that a persistent detection of EBV-DNA in peripheral blood of adults in a P. vivax semi-immune population may impact the long-term immune response to major malaria vaccine candidates.
Collapse
Affiliation(s)
| | | | | | | | | | - Taís N. de Souza
- Instituto René Rachou/FIOCRUZ Minas, Belo Horizonte, Minas Gerais, Brazil
| | - Camilla V. Pires
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Talita A. F. Monteiro
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde (IEC/SVS/MS), Belém, Pará, Brazil
| | - Jaap M. Middeldorp
- Department of Pathology, Free University Medical Center, Amsterdam, The Netherlands
| | - Irene S. Soares
- Faculdade de Ciências Farmacêuticas, Universidade de São Paulo (USP), São Paulo, Brazil
| | - Cor J. F. Fontes
- Julio Müller School Hospital, Faculdade de Medicina, Universidade Federal de Mato Grosso, Cuiabá, Mato Grosso, Brazil
| | - Francis B. Ntumngia
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - John H. Adams
- Center for Global Health and Infectious Diseases Research, Department of Global Health, College of Public Health, University of South Florida, Tampa, Florida, United States of America
| | - Flora S. Kano
- Instituto René Rachou/FIOCRUZ Minas, Belo Horizonte, Minas Gerais, Brazil
| | - Luzia H. Carvalho
- Instituto René Rachou/FIOCRUZ Minas, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| |
Collapse
|
9
|
Readiness of Mozambique Health Facilities to Address Undernutrition and Diarrhea in Children under Five: Indicators from 2018 and 2021 Survey Data. Healthcare (Basel) 2022; 10:healthcare10071200. [PMID: 35885727 PMCID: PMC9319856 DOI: 10.3390/healthcare10071200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/26/2022] Open
Abstract
The World Health Organization’s systems framework shows that service delivery is key to addressing pressing health needs. Inadequate healthcare and the lack of healthcare services are factors associated with undernutrition and diarrhea in children under five, two health conditions with high morbi-mortality rates in Mozambique. The aim of the analysis was to determine the readiness score of nutrition and diarrhea services for children under five and the influence of malaria and HIV (Human Immunodeficiency Virus) service readiness on the readiness of these two services. A total of 1644 public health facilities in Mozambique were included from the 2018 Service Availability and Readiness Assessment. Additionally, a cross-sectional study was conducted to determine the availability and readiness scores of nutrition services in 2021 in five referral health facilities. The availability of nutrition and diarrhea services for children is low in Mozambique, with both scoring below 75%. Major unavailability was observed for human resources, guidelines, and training dimensions. Diarrhea (median (IQ): 72.2% (66.7 to 83.3)) and nutrition service readiness (median (IQ): 57.1% (52.4 to 57.1)) scores were significantly different (p < 0.001), while it is desirable for both services to be comprehensively ready. Nutrition services are positively associated with diarrhea service readiness and both services are associated with malaria and HIV service readiness (p < 0.05). None of the health facilities had all tracer items available and none of the facilities were considered ready (100%). There is a persisting need to invest comprehensively in readiness dimensions, within and across child health services.
Collapse
|