What question did this study set out to answer?

This research aims to compare malaria features between individuals living with and without HIV in Libreville, Gabon.

February 19, 2026Open Access

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

Key Points

This research aims to compare malaria features between individuals living with and without HIV in Libreville, Gabon.
Conducted a cross-sectional study at the hospital in Libreville.
Screened participants for malaria and enrolled those infected with Plasmodium.
Collected data on socio-demographic characteristics, clinical presentations, and laboratory parameters.
Utilized bivariate and multivariable logistic regression for data analysis.
Among 1,192 individuals tested, 56 PLHIV and 66 HIV-negative were infected with Plasmodium falciparum.
Asymptomatic malaria was more common in HIV-negative participants (60.6%) compared to PLHIV (25.0%).
Severe malaria was significantly more frequent in PLHIV (48.2%) versus HIV-negative individuals (12.1%).
Cotrimoxazole use was associated with reduced Plasmodium falciparum parasitemia (p = 0.03).
Median CD4+ count was lower in PLHIV with severe malaria (150 cells/µL) compared to those asymptomatic (304 cells/µL).

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. Methods 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. Results 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 ). Conclusion 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.

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

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