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dc.contributor.authorMbale, Emmie W.
dc.contributor.authorMoxon, Christopher A.
dc.contributor.authorMukaka, Mavuto
dc.contributor.authorChagomerana, Maganizo
dc.contributor.authorGlover, Simon
dc.contributor.authorChisala, Ngawina
dc.contributor.authorOmar, Sofia
dc.contributor.authorMolyneux, Malcolm
dc.contributor.authorSeydel, Karl
dc.contributor.authorCraig, Alister G.
dc.contributor.authorTaylor, Terrie
dc.contributor.authorHeyderman, Robert S.
dc.contributor.authorMallewa, Macpherson
dc.identifier.citationMbale , E W , Moxon , C A , Mukaka , M , Chagomerana , M , Glover , S , Chisala , N , Omar , S , Molyneux , M , Seydel , K , Craig , A G , Taylor , T , Heyderman , R S & Mallewa , M 2016 , ' HIV coinfection influences the inflammatory response but not the outcome of cerebral malaria in Malawian children ' , Journal of Infection , vol. 73 , no. 3 , pp. 189-199 .
dc.identifier.otherPURE: 243407349
dc.identifier.otherPURE UUID: 28f4e21f-3c31-44f5-be32-8f7e37e0c24a
dc.identifier.otherRIS: urn:71DAA3D48D1FC0F83EFA7D22809A5275
dc.identifier.otherScopus: 84991058690
dc.identifier.otherWOS: 000383380500002
dc.descriptionThis work was supported by grants from the NIH (T.E.T., 5R01AI034969-14) and a Clinical Fellowship from The Wellcome Trust, United Kingdom (C.A.M, 88758). The Malawi-Liverpool-Wellcome Clinical Research Programme is supported by core funding from The Wellcome Trust, UK.en
dc.description.abstractObjectives. Study of the effect of HIV on disease progression in heterogeneous severe malaria syndromes with imprecise diagnostic criteria has led to varying results. Characteristic retinopathy refines cerebral malaria (CM) diagnosis, enabling more precise exploration of the hypothesis that HIV decreases the cytokine response in CM, leading to higher parasite density and a poor outcome. Methods. We retrospectively reviewed data on clinical progression and laboratory parameters in 877 retinopathy-positive CM cases admitted 1996-2011 (14.4% HIV-infected) to a large hospital in Malawi. Admission plasma levels of TNF, interleukin-10, and soluble intercellular adhesion molecule (sICAM-1) were measured by ELISA in 135 retinopathy-positive CM cases. Results. HIV-infected CM cases had lower median plasma levels of TNF (p=0.008), interleukin-10 (p=0.045) and sICAM-1 (p=0.04) than HIV-uninfected cases. Although HIV-infected children were older and more likely to have co-morbidities, HIV-status did not significantly affect parasite density (p=0.90) or outcome (24.8% infected, vs. 18.5% uninfected; p=0.13). Conclusions. In this well-characterised CM cohort, HIV-coinfection was associated with marked blunting of the inflammatory response but did not affect parasite density or outcome. These data highlight the complex influence of HIV on severe malaria and bring into question systemic inflammation as a primary driver of pathogenesis in human CM.
dc.relation.ispartofJournal of Infectionen
dc.rights© 2016 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association. This is an open access article under the CC BY license (
dc.subjectCerebral Malariaen
dc.subjectRA0421 Public health. Hygiene. Preventive Medicineen
dc.subjectRJ101 Child Health. Child health servicesen
dc.titleHIV coinfection influences the inflammatory response but not the outcome of cerebral malaria in Malawian childrenen
dc.typeJournal articleen
dc.description.versionPublisher PDFen
dc.contributor.institutionUniversity of St Andrews.School of Medicineen
dc.description.statusPeer revieweden

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