IMPACT OF PARASITOLOGICAL, CLINICAL AND RENAL-HEPATIC BIOMARKER RESPONSES IN CHILDREN BELOW FIVE-YEAR OLD COINFECTED WITH MALARIA AND HIV IN WESTERN KENYA

Abstract

Malaria and HIV remain major causes of morbidity and mortality among children under five years in sub-Saharan Africa. Their co-infection presents a compounded health challenge, particularly in Western Kenya where Plasmodium falciparum transmission and HIV prevalence are both high. This study aimed to determine the burden of parasitemia and host biomarker responses in children aged below five years co-infected with P. falciparum and HIV. A cross-sectional case-control study involving 138 children aged 6–59 months was conducted at Kakamega County General Teaching and Referral Hospital. Parasitological diagnosis was done by microscopy and rapid diagnostic tests, while biochemical assays evaluated renal and hepatic function. Children co-infected with malaria and HIV were generally younger than those with HIV mono-infection, suggesting that mother-to-child acquired HIV predisposes to increased malaria susceptibility and severity in early life. The co-infected group had significantly higher median parasitemia (1,870 parasites/µL; range: 1,806–80,025), indicating intense transmission. Female children were more affected than males, suggesting possible gender-based differences in exposure, careseeking behavior, or immune response. Renal markers serum creatinine, urea, and blood urea nitrogen were significantly elevated in the co-infected group, reflecting early renal impairment likely linked to immune complex deposition and microvascular obstruction. Hepatic markers ALT, AST, GGT, total and direct bilirubin were also markedly raised, indicating hepatocellular injury and cholestasis. Total protein, albumin, and globulins were significantly higher in co-infected children, suggesting polyclonal B-cell activation and hypergammaglobulinemia driven by chronic immune stimulation. Among the biochemical markers, LDH, creatinine, and ALP exhibited high sensitivity and specificity in predicting organ dysfunction, while GGT, bilirubin, and total protein demonstrated high sensitivity but lower specificity. Receiver Operating Characteristic (ROC) analyses showed modest predictive value (AUC 0.43–0.69) for these markers in identifying renal and hepatic dysfunction. The findings suggest that combining hepatic and renal markers could enhance diagnostic accuracy in co-infected children. P. falciparum and HIV co-infection in children under five years significantly disrupts renal and hepatic function, reflecting compounded immune and metabolic stress. Elevated creatinine, bilirubin, and transaminases indicate potential for these markers to serve as adjunct diagnostic and prognostic tools in endemic areas. The study underscores the need to integrate biochemical assessment into pediatric malaria management, especially in HIV-prevalent regions. Routine monitoring of renal and hepatic function is recommended for timely identification of co-infected children at risk of severe outcomes. Further longitudinal and multi-center studies should investigate the mechanistic pathways underlying biomarker alterations and validate context-specific diagnostic thresholds for clinical use.