Maternal malaria and perinatal HIV transmission, western Kenya.
To determine whether maternal placental malaria is associated with an increased risk for perinatal mother-to-child HIV transmission (MTCT), we studied HIV-positive women in western Kenya. We enrolled 512 mother-infant pairs; 128 (25.0%) women had placental malaria, and 102 (19.9%) infants acquired HIV perinatally. Log10 HIV viral load and episiotomy or perineal tear were associated with increased perinatal HIV transmission, whereas low-density placental malaria (<10,000 parasites/mL) was associated with reduced risk (adjusted relative risk [ARR] 0.4). Among women dually infected with malaria and HIV, high-density placental malaria (>10,000 parasites/mL) was associated with increased risk for perinatal MTCT (ARR 2.0), compared to low-density malaria. The interaction between placental malaria and MTCT appears to be variable and complex: placental malaria that is controlled at low density may cause an increase in broad-based immune responses that protect against MTCT; uncontrolled, high-density malaria may simultaneously disrupt placental architecture and generate substantial antigen stimulus to HIV replication and increase risk for MTCT.
Ayisi
John G
JG
Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya.
van Eijk
Anna M
AM
Newman
Robert D
RD
ter Kuile
Feiko O
FO
Shi
Ya Ping
YP
Yang
Chunfu
C
Kolczak
Margarette S
MS
Otieno
Juliana A
JA
Misore
Ambrose O
AO
Kager
Piet A
PA
Lal
Renu B
RB
Steketee
Richard W
RW
Nahlen
Bernard L
BL
D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008288:Malaria / Q000150:complications / Q000821:virology*; D015999:Multivariate Analysis; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000821:virology*; D012307:Risk Factors