title: Maternal malaria and perinatal HIV transmission, western Kenya.
abstract: 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.
authors.affiliation: Centre for Vector Biology and Control Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: John G
authors.initials: JG
authors.lastname: Ayisi
authors.forename: Anna M
authors.initials: AM
authors.lastname: van Eijk
authors.forename: Robert D
authors.initials: RD
authors.lastname: Newman
authors.forename: Feiko O
authors.initials: FO
authors.lastname: ter Kuile
authors.forename: Ya Ping
authors.initials: YP
authors.lastname: Shi
authors.forename: Chunfu
authors.initials: C
authors.lastname: Yang
authors.forename: Margarette S
authors.initials: MS
authors.lastname: Kolczak
authors.forename: Juliana A
authors.initials: JA
authors.lastname: Otieno
authors.forename: Ambrose O
authors.initials: AO
authors.lastname: Misore
authors.forename: Piet A
authors.initials: PA
authors.lastname: Kager
authors.forename: Renu B
authors.initials: RB
authors.lastname: Lal
authors.forename: Richard W
authors.initials: RW
authors.lastname: Steketee
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Nahlen
mesh_terms: 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