Association of HIV and malaria with mother-to-child transmission, birth outcomes, and child mortality.
OBJECTIVE
To assess the impact of HIV and malaria coinfection on mother-to-child HIV transmission (MTCT) and adverse birth outcomes.


METHODS
One hundred nine HIV-positive mother-infant pairs with a malaria diagnosis were identified in a community cohort and followed up postpartum. Maternal malaria was diagnosed by a rapid immunochromatographic test (ICT) on sera and histopathologic examination of placenta. Infant HIV was diagnosed within 6 weeks of birth using polymerase chain reaction (PCR) to capture in-utero and intrapartum HIV transmission. Log binomial models were used to assess the relative risk of MTCT, low birth weight, and preterm birth associated with malaria.


RESULTS
Approximately 17.4% of infants were HIV positive at or around birth, and the prevalence of serologic and placental malaria were 31% and 32%, respectively. HIV-positive mothers with serological ICT malaria were significantly more likely to have low-birth-weight infants, and low-birth-weight infants had significantly higher risk of MTCT compared with infants of normal birth weight. Although placental and serologic ICT malaria were significantly associated with MTCT, after adjusting for maternal HIV viral load, the risk of MTCT was significantly increased only for mothers coinfected with placental malaria (relative risk [RR] = 7.9, P = 0.025).


CONCLUSIONS
Placental malaria increases the risk of MTCT after adjustment for viral load. Programs should focus on enhanced malaria prevention during pregnancy to decrease the risk of adverse birth outcomes and MTCT.
Brahmbhatt
Heena
H
Department of Population and Family Health Sciences, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD 21205, USA. hbrahmbh@jhsph.edu
Sullivan
David
D
Kigozi
Godfrey
G
Askin
Fred
F
Wabwire-Mangenm
Fred
F
Serwadda
David
D
Sewankambo
Nelson
N
Wawer
Maria
M
Gray
Ronald
R
D000328:Adult; D000953:Antigens, Protozoan / Q000032:analysis; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000401:mortality / Q000635:transmission*; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D016778:Malaria, Falciparum / Q000150:complications* / Q000175:diagnosis; D015999:Multivariate Analysis; D010920:Placenta / Q000737:chemistry / Q000469:parasitology / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000469:parasitology / Q000821:virology; D011256:Pregnancy Outcome; D015800:Protozoan Proteins / Q000032:analysis; D014454:Uganda
D000953:Antigens, Protozoan; C514457:HRP-2 antigen, Plasmodium falciparum; D015800:Protozoan Proteins