Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe.
OBJECTIVE
To investigate the effect of isolated or concomitant infection with malaria and HIV on pregnancy and neonatal outcome.


METHODS
Data were collected on pregnant women admitted during the rainy seasons in the obstetric division of a district referral hospital in northern Zimbabwe in 2000 and 2001. The effects of malaria and HIV infection were determined by multivariate analysis.


RESULTS
The prevalence of HIV seropositivity and symptomatic malaria in 986 pregnant women was 8.3% and 14.7%, respectively. HIV-infected women were more likely to develop malaria attacks during pregnancy than seronegative women (odds ratio [OR] = 3.96, 95% confidence interval (CI): 2.42-6.46). Malaria and HIV infections were associated with increased risk of stillbirth (OR = 4.74, 95% CI: 1.34-16.78) and preterm delivery (OR = 4.10, 95% CI: 2.17-7.75), respectively. They were independently associated with increased risk of low birth weight (malaria: OR = 10.09, 95% CI: 6.50-15.65; HIV: OR = 3.16, 95% CI: 1.80-5.54) and very low birth weight (malaria: OR = 5.04, 95% CI: 1.00-25.43; HIV: OR = 10.74, 95% CI: 2.12-54.41), low Apgar score (malaria: OR = 4.45, 95% CI: 1.42-13.94; HIV: OR = 5.94, 95% CI: 1.66-21.30), and fetal growth restriction (malaria: OR = 3.98, 95% CI: 2.51-6.30; HIV: OR = 4.07, 95% CI: 2.40-6.92). Dual infection with malaria and HIV was associated with increased risk of maternal, perinatal, and early infant death.


CONCLUSIONS
Women with single HIV or malaria infection have a significantly increased risk of adverse outcomes of pregnancy and childbirth. Dual infection has additional detrimental effects on maternal and infant survival in an area where HIV and malaria coexist.
Ticconi
Carlo
C
Department of Surgery, Section of Obstetrics and Gynecology, University of Rome Tor Vergata, Via Montpellier 1-00173 Rome, Italy. ticconi@med.uniroma2.it
Mapfumo
Monica
M
Dorrucci
Maria
M
Naha
Neela
N
Tarira
Elizabeth
E
Pietropolli
Adalgisa
A
Rezza
Giovanni
G
D000022:Abortion, Spontaneous / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000818:Animals; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000473:pathology; D015497:HIV-1 / Q000254:growth & development*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000502:physiology; D016778:Malaria, Falciparum / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D007752:Obstetric Labor, Premature / Q000473:pathology; D010963:Plasmodium falciparum / Q000254:growth & development*; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000469:parasitology* / Q000473:pathology / Q000821:virology*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D015030:Zimbabwe