In settings of year-round malaria transmission where most adults are semi-immune to malaria, the incidence of parasitaemia and clinical malaria are increased in individuals with HIV infection

[5]. Malaria presents non-specifically with fever, headache, arthralgia, myalgia, diarrhoea and sometimes features of bacterial infection. Patients may be severely unwell and hypotensive, requiring intensive care unit (ICU) involvement early in the hospital admission. Other than severity there is no evidence that HIV compound screening assay serostatus modifies presentation. Complications of malaria include hyperparasitaemia, acute renal failure, hypoglycaemia, disseminated intravascular coagulopathy, lactic acidosis, fulminant hepatic failure and cerebral malaria [6]. Mortality is still around 20% with higher rates in HIV-seropositive individuals when treated in Africa. Controversy remains concerning the impact of malaria on mother-to-child transmission of HIV but HIV-seropositive women with malaria have an increased incidence of anaemia, infants with low birth weight, prematurity and infant mortality due to malarial parasites

preferentially binding to the placenta [7]. Malaria should be diagnosed in the same way as in HIV-seronegative individuals, using a combination of thick and thin blood films with or without a rapid diagnostic (antigen) test in ABT-263 solubility dmso HIV-seropositive individuals (category IV recommendation). In practice, this involves considering the diagnosis in anyone with fever who has returned from an endemic area. Falciparum malaria usually presents within 3 months of their return but non-falciparum malaria may recrudesce many years after their return. There is little information on how HIV may modify this but partial immunity may delay the presentation of falciparum malaria. Malaria should be suspected in anyone returning from an endemic area, as the presentation, especially in the semi-immune person, is very variable. Diagnosis is made by a thick and thin blood film although highly sensitive and specific diagnostic dipsticks now exist [8–10]. Thick films (to diagnose

malaria and estimate the percentage parasitaemia) and Idelalisib cost thin films (for speciation) should be collected on all patients (category IV recommendation) [6]. Rapid diagnostic tests for malaria antigens may be helpful if malaria is suspected but blood films are negative. In HIV-seronegative individuals they are less sensitive but are useful for laboratories with less experience in interpreting malaria blood films [6]. There is limited information on their performance in HIV-seropositive individuals. Current guidelines recommend that any patient considered to be at risk of viral haemorrhagic fever should have a malaria film done under category 3 conditions first [11]. Follow the World Health Organization guidelines [12].