Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda.
BACKGROUND
HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS) and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP). TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women.


METHODS
This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP) in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR.


RESULTS
Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW). Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used.


CONCLUSIONS
Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a considerable impact on the burden of LBW in this population.
Newman
Patrick M
PM
School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94131, USA.
Wanzira
Humphrey
H
Tumwine
Gabriel
G
Arinaitwe
Emmanuel
E
Waldman
Sarah
S
Achan
Jane
J
Havlir
Diane
D
Rosenthal
Philip J
PJ
Dorsey
Grant
G
Clark
Tamara D
TD
Cohan
Deborah
D
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000469:parasitology / Q000821:virology; D000328:Adult; D000962:Antimalarials / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004338:Drug Combinations; D005260:Female; D005492:Folic Acid; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D011247:Pregnancy; D015597:Pregnancy Complications, Parasitic / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D011739:Pyrimethamine / Q000627:therapeutic use; D012307:Risk Factors; D013413:Sulfadoxine / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D013413:Sulfadoxine; D005492:Folic Acid; D011739:Pyrimethamine