# Clinical and biological features of complicated and asymptomatic malaria among PLHIV and HIV-negative adults: An observational study in Libreville, Gabon

## TL;DR

This study compares malaria symptoms in HIV-positive and HIV-negative adults in Gabon, finding that severe malaria is more common in those with HIV.

## Contribution

The study provides new insights into the differing clinical manifestations of malaria in PLHIV and HIV-negative individuals in an endemic region.

## Key findings

- Severe malaria was significantly more common in PLHIV compared to HIV-negative individuals.
- Asymptomatic malaria was more frequent in HIV-negative participants than in PLHIV.
- CTX chemoprophylaxis was associated with reduced Plasmodium falciparum parasitemia in PLHIV.

## Abstract

Malaria and HIV remain major public health challenges in sub-Saharan Africa. This study described the spectrum of malaria in people living with HIV (PLHIV) and HIV-negative adults in Gabon, where both diseases are endemic.

A cross-sectional study was conducted at the Centre Hospitalier Universitaire de Libreville from September 2021 to October 2022. Asymptomatic and febrile PLHIV and HIV negative volunteers were screened for malaria and Plasmodium-infected individuals enrolled in the study. Data collected included socio-demographic characteristics, clinical presentation, cotrimoxazole use, antiretroviral treatment, and laboratory parameters, such as parasitaemia, haemoglobin levels and CD4+ cell counts. Data from PLHIV and HIV-negative participants were compared using bivariate and multivariable logistic regression analysis.

Among the 1.192 individuals tested, 513 were PLHIV and 599 HIV-negative. Overall, 56 Plasmodium falciparum-infected PLHIV and 66 HIV-negative individuals were enrolled. Asymptomatic malaria was more frequent among HIV-negative participants (60.6% vs 25.0%), while severe malaria was significantly more common among HIV-positive patients (48.2% vs 12.1%) (p < 0.01). Prostration (16.7%), repeated seizures (14.3%), impaired consciousness (26.2%), severe anaemia (14.3%) and hypoglycemia (11.9%) predominated in PLHIV. Conversely, vomiting (26.9%) and high parasitemia (23.1%) were more frequent in HIV-negative patients. CTX chemoprophylaxis was associated with a reduction in Plasmodium falciparum parasitemia (p = 0.03). The median CD4 + cell count was significantly lower in PLHIV with severe malaria (150 [IQR: 90-204] cells/µL) compared to those with asymptomatic (304 [IQR: 189-476] cells/µL) (p = 0.018).

Compared to HIV negative, asymptomatic malaria was less frequent while severe malaria predominantly affects PLHIV with advanced immunosuppression, highlighting the importance of early detection and management of co-infection to reduce morbidity. Further studies are needed to investigate the neurological manifestations and the impact of prophylactic strategies in Libreville.