CHAPTER ONE

1.0                                              INTRODUCTION

1.1     Background of study

Malaria and HIV are among the two most important global health problems of developing countries. They cause more than 4 million deaths a year (UNAIDS/WHO, 2004). Malaria, sometimes called the “king of diseases”, is caused by protozoan parasites of the genus Plasmodium. It is one of the leading causes of illness and death in the world (WHO, 2004).

Nine out of ten of these deaths occur in Africa and the rest occurs in Asia and Latin America, being the world’s most prevalent vector-borne disease. It is the fourth leading cause of death of children under the age of five years and pregnant women in developing countries (Martens and Hall, 2000; Rowe et al., 2000).

The proportion increases each year because of deteriorating health systems, growing drug and insecticide resistance, climate change and natural disasters (WHO, 2000)

HIV/AIDS is also one of the most destructive epidemics the world has ever witnessed. In 2007 an estimated 33.2 million people were living with HIV worldwide, while 2.5 million of these people were children under 15 years old. Furthermore, 420,000 children under 15 years were newly infected with HIV in 2007.

Nearly 90% of all HIV-positive children live in sub-Saharan Africa. In Ethiopia, while 66% of the population is at risk of malaria, 1.5 million people are infected with

HIV (Corbett et al., 2000; Mitike et al., 2002).

In addition to this increased prevalence in developing countries Malaria and HIV/AIDS overlap geographically, primarily in sub-Saharan Africa, Southeast Asia and South America. While infection with either malaria or HIV/AIDS can cause illness and death, infection with one can make infection with the other worse and/or

more difficult to treat. The two diseases have particularly devastating effects for those living in malaria endemic regions throughout the world. Pregnant women suffer particularly serious consequences when infected with both HIV/AIDS and malaria. HIV/AIDS can increase the adverse effects of malaria, including anemia and placental malaria infection (Ayisi, 2003).

These two infections interact bidirectionally and synergistically with each other. HIV infection can increase the risk and severity of malaria infection and the increased parasite burdens might facilitate higher rates of malaria transmission. Individuals in malaria-endemic areas that are considered semi-immune to malaria can also develop clinical malaria if they are infected with HIV. Also malaria infection is associated with strong CD4+ cell activation and up-regulation of proinflammatory cytokines, providing an ideal microenvironment for the spread of the virus among CD4 + cells and thus for rapid HIV-1 replication (WHO, 2004).

Understanding of the human immune response to malaria and HIV leads us to expect that either infection might influence the clinical course of the other. Many other types of infections are associated with at least a transient increase in HIV viral load. Hence, it is logical to expect malaria to do the same and potentially to accelerate HIV disease progression.

On the other hand, the control of malaria parasitaemia is immune mediated, and this prevents most malarial infections from becoming clinically apparent in semi-immune adults in endemic areas (Chandramohan and Greenwood, 1998). The immune deficiency caused by HIV infection should, in theory, reduce the immune response to malaria parasitaemia and therefore increase the frequency of clinical attacks of malaria.

So HIV infection affects the clinical presentation, severity and response to treatment of malaria cases. The clinical impact of these interactions varies depending on the intensity of malaria transmission in the area (and consequent level of host immunity) and the individual affected (e.g. adult, child or pregnant woman) (Kamya, 2000). However, in different malaria HIV co-endemic countries there has been little or no research conducted regarding this topic. The aim of this article is, therefore, to review existing information about HIV malaria interactions, the effect of malaria on HIV transmission and progression and the implications related to prevention and treatment of coinfection.

• Statement of problems

Infection of HIV and malaria are among the two most important global health problems of developing countries including Nigeria which was reported to cause more than 4 million deaths a year, with HIV infection increasing the risk of and severity of malaria infection and burdens.HIV may facilitates geographic expansion of malaria in areas where HIV prevalence is high. Therefore, repeated increase in HIV viral load due to recurrent co-infection may be an important factor promoting the spread in sub-Sahara Africa as areas of the world with high rates of malaria also carry a heavy burden of HIV.

Another problem is the interactions between HIV and pathogenic organisms especially malaria parasites constitute a concern of public health implication, as opportunistic infections caused by viruses, parasites, bacteria, fungi and other pathogens remain as major causes of mortality among HIV patients.

It is against this backdrop that this research evaluates malaria treatment among people living with HIV/AIDs in Owerri, Imo State.

1.3     Objective of the research

The broad objective of the study is toevaluate malaria treatment among people living with HIV/AIDs, however, the specific objectives are:

1. To ascertain the first line of actions by the HIV/AIDs patients when infected with malaria
2. To ascertain the types of treatment/antimalarial drugs used
3. To ascertain the source of treatment
4. To ascertain the adherence to treatment
5. To ascertain the challenges of treatment
6. To ascertain the relationship between socioclinical characteristics and malaria treatment

1.4     Research questions

The research questions to guide this study are as follows:

1. What are the first line of actions by the HIV/AIDs patients when infected with malaria?
2. What are the types of treatment/antimalarial drugs used by HIV/AIDs patients?
3. What are the source of treatment?
4. Do HIV/AIDs patients adhere to treatment?
5. What the challenges are of experienced during the cause of treatment?
6. Is there any relationship between socioclinical characteristics and malaria treatment?

1.5    Justification of research

An important aspect to justify this research is the potential interaction between HIV and malaria which has effect on HIV-associated immunosuppression on response to antimalarial therapy. Case series and retrospective reviews in the past compared the antimalarial drug efficacy among HIV-infected and HIV-uninfected patients with mixed results reported. This study will go a long way in justifying malaria treatment among people living with HIV/AIDs in Owerri, Imo state.