Role of HIV-1 and Bacteremia Co-infection in Promoting Inflammatory Mediator production in Kenyan Children with Severe Malarial Anemia

Severe anemia is the primary outcome of childhood malaria in holoendemic malaria transmission regions such as western Kenya. HIV-1 and bacteremia are equally important diseases in Kenyan children. Anemia is also the hallmark trait of pediatric HIV-1 infection, and despite our previous reports of exacerbated anemia in malaria/HIV-1 co-infected childrena, we also observed significantly lower parasitemias without worsening anemia in malaria/bacteremia co-infected children. Abundant production of pro-inflammatory cytokines is known to adversely affect erythropoiesis and is common to malaria, HIV-1, and bacteremia. As such, we performed a comprehensive bead-based 25-plex Multiplex assay to identify cytokines patterns and profiles associated with negative and positive hematolgic outcomes in co-infected children. Children in Aims 1 and 2 infected with P. falciparum malaria (Pf[+], aged 3-36 mos., n=542) were stratified into three groups: HIV-1 negative (HIV-1[-]/Pf[+]); HIV-1 exposed (HIV-1[exp]/Pf[+]); and HIV-1 infected (HIV-1[+]/Pf[+]). In Aim 3, malaria and bacteremia co-infected children (n=192) were divided into three categories: malaria alone, Pf[+]; Gram negative bacteremia/malaria co-infected, G[-]/Pf[+]; and Gram positive bacteremia/malaria co-infected, G[+]/Pf[+]. Univariate, correlational, and hierarchical regression analyses were used to determine differences among the groups and to define predictors of worsening anemia. Aim 1 analyses revealed HIV-1[+]/Pf[+] children had significantly more malarial pigment-containing neutrophils (PCN), monocytosis, increased severe anemia (Hb