Maternal syphilis infection is associated with increased risk of mother-to-child transmission of HIV in Malawi.
OBJECTIVE
To determine the association between maternal syphilis and HIV mother-to-child transmission (MTCT).


METHODS
Prospective cohort study.


METHODS
Pregnant women admitted at Queen Elizabeth Central Hospital (Malawi) in late third trimester were screened for HIV (by HIV rapid tests) and syphilis (by rapid plasma regain test and Treponema pallidum hemagglutination assay). HIV-infected women and their infants received nevirapine, according to the HIVNET 012 protocol. They were followed up at 6 and 12 weeks postpartum. Infant HIV infection was diagnosed by DNA PCR.


RESULTS
Of the 1155 HIV-infected women enrolled, 1147 had syphilis test results, of whom 92 (8.0%) were infected. Only 751 HIV-positive women delivered live singleton infants who were tested for HIV at birth. Of these, 65 (8.7%) were HIV-infected, suggesting in utero (IU) HIV MTCT. Of the 686 infants who were HIV-negative at birth, 507 were successfully followed up. Of these, 89 (17.6%) became HIV-infected, suggesting intrapartum/postpartum (IP/PP) HIV MTCT. Maternal syphilis was associated with IU HIV MTCT, after adjusting for maternal log10 HIV-1 viral load and low birth weight (LBW) [adjusted relative risk (ARR), 2.77; 95% CI, 1.40-5.46]. Furthermore, maternal syphilis was associated with IP/PP HIV MTCT (ARR, 2.74; 95% CI, 1.58-4.74), after adjusting for recent fever, breast infection, LBW and maternal log10 HIV-1 viral load.


CONCLUSIONS
Maternal syphilis is associated with IU and IP/PP HIV MTCT. Screening and early treatment of maternal syphilis during pregnancy may reduce pediatric HIV infections.
Mwapasa
Victor
V
Department of Community Health, College of Medicine, Blantyre, Malawi, USA.
Rogerson
Stephen J
SJ
Kwiek
Jesse J
JJ
Wilson
Paul E
PE
Milner
Danny
D
Molyneux
Malcolm E
ME
Kamwendo
Deborah D
DD
Tadesse
Eyob
E
Chaluluka
Ebbie
E
Meshnick
Steven R
SR
D000328:Adult; D018791:CD4 Lymphocyte Count; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008295:Malawi / Q000453:epidemiology; D009035:Mothers; D009099:Multiple Birth Offspring; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000473:pathology; D011256:Pregnancy Outcome; D011446:Prospective Studies; D013587:Syphilis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology; D014210:Treponema pallidum; D019562:Viral Load
D004269:DNA, Bacterial