HIV and malaria co-infection is a major public health issue as both diseases affect mostly the sub-Saharan Africa. This study aimed at establishing the magnitude of the impact of HIV on the severity of malaria. An electronic search was conducted in Google Scholar and PubMed to find 10 relevant articles with 10,055 participants from five African countries. The following criteria were used to select the studies: The studies must be prospective cohort, used effect size must be odds ratio (OR) and the studies had to compare HIV and malaria severity.The pooled analysis, using a fixed-effect model, revealed that HIV-positive individuals have significantly higher odds of experiencing severe malaria outcomes compared to HIV-negative individuals (pooled OR: 1.70; 95% CI: 1.54-1.87; p < 0.001). Subgroup analyses further elucidated this relationship, showing nearly doubled odds of severe malaria (OR: 1. Malaria incidence was 1.88 times higher (OR: 1.88; 95% CI: 1.46-2.42), Malaria-related mortality risk was 2.32 times higher (OR: 2.32; 95% CI: 1.68-3.21) and severe clinical manifestations were 1.72 times more likely to occur among HIV-positive patients.The results of this study support the provision of HIV and malaria interventions in co-endemic areas. Clinicians should always consider severe malaria in HIV-positive patients. This meta-analysis offers strong evidence on the negative impact of HIV on malaria outcomes and highlights the need for a new approach to these diseases. More research should be conducted on how to manage co-infected individuals while preventing increased risk of malaria in HIV positive people.