title: Placental malaria and mother-to-child transmission of human immunodeficiency virus-1 in rural Rwanda.
abstract: We conducted a nested case-control study of placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1) within a prospective cohort of 627 mother-infant pairs followed from October 1989 until April 1994 in rural Rwanda. Sixty stored placentas were examined for PM and other placental pathology, comparing 20 HIV-infected mother-infant (perinatal transmitter) pairs, 20 HIV-uninfected pairs, and 20 HIV-infected mothers who did not transmit to their infant perinatally. Of 60 placentas examined, 45% showed evidence of PM. Placental malaria was associated with increased risk of MTCT of HIV-1 (adjusted odds ratio [aOR] = 6.3; 95% confidence interval [CI] = 1.4-29.1), especially among primigravidae (aOR = 12.0; 95% CI = 1.0-150; P < 0.05). Before antiretroviral therapy or prophylaxis, PM was associated with early infant HIV infection among rural Rwandan women living in a hyper-endemic malaria region. Primigravidae, among whom malaria tends to be most severe, may be at higher risk.
authors.affiliation: David Geffen School of Medicine, University of California, Los Angeles, CA, USA. bulterys@ucla.edu
authors.forename: Philip L
authors.initials: PL
authors.lastname: Bulterys
authors.forename: Ann
authors.initials: A
authors.lastname: Chao
authors.forename: Sudeb C
authors.initials: SC
authors.lastname: Dalai
authors.forename: M Christine
authors.initials: MC
authors.lastname: Zink
authors.forename: Abel
authors.initials: A
authors.lastname: Dushimimana
authors.forename: David
authors.initials: D
authors.lastname: Katzenstein
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Saah
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D010920:Placenta / Q000469:parasitology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult