INTRODUCTION Malaria is endemic in many areas of India and repeated infections with Plasmodium falciparum and P. vivax occur. Malaria parasitemia differs in instances of asymptomatic and clinical malaria and the degree of parasitemia may influence the pathological and biochemical presentations in these patients (1,2). Influence of therapy to avoid HIV on malaria infection is controversial. Available studies have limited sample sizes and failed to demonstrate any association of malaria with HIV among hospitalized patients from areas with stable malaria transmission (3). It has been postulated that HIV infection alters clinical presentation of malaria (4). Further, treatment failure of anti-malarials is reported in HIV patients (5,6) which also has been contradicted (7). Fever, a major manifestation present both in HIV and malaria patients is not only due to infection, but also of many other common infections. An immune reconstitution syndrome along with adverse effects of antiretroviral drugs and other medicines lead to a febrile illness too (5,6). The fact that people in malaria endemic areas may have asymptomatic malarial parasitemia that complicates the diagnosis of febrile illness in malaria and HIV co-infected patients.