HIV This Week

Brahmbhatt H, Sullivan D, Kigozi G, Askin F, Wabwire-Mangenm F, Serwadda D, Sewankambo N, Wawer M, Gray R. Association of HIV and Malaria With Mother-to-Child Transmission, Birth Outcomes, and Child Mortality. J Acquir Immune Defic Syndr. 2008;47(4):472-476.

Brahmbhatt and colleagues set out to assess the impact of HIV and malaria coinfection on mother-to-child HIV transmission (MTCT) and adverse birth outcomes. 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 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. 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 immunochromatographic test 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 immunochromatographic test 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). The authors conclude that placental malaria increases the risk of MTCT after adjustment for viral load. Programmes should focus on enhanced malaria prevention during pregnancy to decrease the risk of adverse birth outcomes and MTCT.

Editors´note: Coinfection with malaria and HIV during pregnancy is known to have adverse consequences for morbidity and mortality of infants. Placental malaria is more prevalent in HIV-positive mothers than HIV-negative mothers. In this study using highly sensitive diagnostic methods, placental malaria in pregnant women with HIV infection increased the risk of mother-to-child HIV transmission, irrespective of maternal viral load. This suggests that prevention of placental malaria in pregnancy is important to prevent HIV transmission to infants.