Background:  Malaria causes 300 million to 500 million clinical episodes and 1 million deaths annually, mostly in sub-Saharan Africa, where global HIV burden is highest. Although important questions remain, the interactions between malaria due to Plasmodium falciparum infection and HIV have become better understood over the past 20 years. In children, HIV transmission may occur as a result of transfusions necessitated by malaria-associated anemia. Adults with advanced HIV are at increased risk for malaria, experience higher density parasitemia and more severe clinical illness, and may not benefit as completely from anti-malarial therapy as HIV-uninfected adults. Provision of daily cotrimoxazole to people with HIV reduces the frequency of malaria, even in areas with documented resistance of P. falciparum to sulfa-based antimalarial drugs. As with many other infections, malaria causes at least transient increases in HIV viral load; the impact of these increases is not clear, but may include higher risk of HIV transmission and possibly acceleration in HIV disease progression. Malaria/HIV interactions are of particular importance in pregnant women. HIV-infected pregnant women have higher frequency and level of placental parasitemia; co-infection with HIV and malaria is associated with higher rates of maternal anemia and delivery of low birth weight infants. There is conflicting evidence concerning the effect of placental malaria on vertical transmission of HIV.

Conclusions:  Expanded resources are available for both malaria and HIV control, for example through the Global Fund for AIDS, Tuberculosis, and Malaria, and United States Government Initiatives. The public health response to the two diseases should include integration of programs where feasible. Available interventions include protection of blood supplies, provision of cotrimoxazole to people with HIV, and provision of insecticide-treated bed nets, particularly to HIV-infected pregnant women.