Maternal malaria and perinatal HIV transmission, western Kenya

被引:74
作者
Ayisi, JG
van Eijk, AM
Newman, RD
ter Kuile, FO
Shi, YP
Yang, CF
Kolczak, MS
Otieno, JA
Misore, AO
Kager, PA
Lal, RB
Steketee, RW
Nahlen, BL
机构
[1] Ctr Dis Control & Prevent, Malaria Branch, Atlanta, GA 30341 USA
[2] Kenya Govt Med Res Ctr, Ctr Vector Biol & Control Res, Kisumu, Kenya
[3] Univ Amsterdam, Amsterdam, Netherlands
[4] Minist Hlth, Kisumu, Kenya
[5] WHO, CH-1211 Geneva, Switzerland
关键词
D O I
10.3201/eid1004.030303
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
To determine whether maternal placental malaria is associated with an increased risk for perinatal mother-to-child HIV transmission (MTCT), we studied HIV-positive women in western Kenya. We enrolled 512 mother-infant pairs; 128 (25.0%) women had placental malaria, and 102 (19.9%) infants acquired HIV perinatally. Log(10) HIV viral load and episiotomy or perineal tear were associated with increased perinatal HIV transmission, whereas low-density placental malaria (<10,000 parasites/muL) was associated with reduced risk (adjusted relative risk [ARR] 0.4). Among women dually infected with malaria and HIV, high-density placental malaria (greater than or equal to10,000 parasites/muL) was associated with increased risk for perinatal MTCT (ARR 2.0), compared to low-density malaria. The interaction between placental malaria and MTCT appears to be variable and complex: placental malaria that is controlled at low density may cause an increase in broad-based immune responses that protect against MTCT;, uncontrolled, high-density malaria may simultaneously disrupt placental architecture and generate substantial antigen stimulus to HIV replication and increase risk for MTCT.
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页码:643 / 652
页数:10
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