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Human Immunodeficiency Virus Co-Infection Increases Placental Parasite Density and Transplacental Malaria Transmission in Western Kenya

Plasmodium falciparum malaria and human immunodeficiency virus (HIV)-1 adversely interact in the context of pregnancy, however little is known regarding the influence of co-infection on the risk of congenital malaria. We aimed to determine the prevalence of placental and congenital malaria and impact of HIV co-infection on trans-placental malaria transmission in 157 parturient women and their infants by microscopy and by quantitative real-time polymerase chain reaction (PCR) in western Kenya. The prevalence of placental and cord blood infections were 17.2% and 0% by microscopy, and 33.1% and 10.8% by PCR. HIV co-infection was associated with a significant increase in placental parasite density (P < 0.05). Cord blood malaria prevalence was increased in co-infected women (odds ratio [OR] = 5.42; 95% confidence interval [CI] = 1.90–15.47) and correlated with placental parasite density (OR = 2.57; 95% CI = 1.80–3.67). A 1-log increase in placental monocyte count was associated with increased risk of congenital infection (P = 0.001) (OR = 48.15; 95% CI = 4.59–505.50). The HIV co-infected women have a significantly increased burden of placental malaria that increases the risk of congenital infection.

Received June 13, 2008. Accepted for publication September 11, 2008.

Acknowledgments: The authors thank the study volunteers for their willingness to participate in this research project. This paper is published with the permission of KEMRI and its Director. We also thank Chris Graham (University of Ottawa), Davidson Hamer (Boston University), Dan Gillis and Janet Raboud (University of Toronto) for their support with study logistics and statistical analysis, and the University of Georgia/KEMRI Kenyan staff (Linda Ambasa, Rodney Bosire, Joab Middii, Stephen Mwalimu, Fenner Odhiambo and Rose Oyucho) without whose efforts sample collection would not have been possible. The authors thank Dr. Rainer Soeller, Associate Director of Research and Development at Qiagen, Hamburg, for his company’s contribution of PCR reagents to this study.

Financial support: This study was funded in part by a CIHR Team Grant in Malaria (KCK), CIHR MT-13721 (KCK), Genome Canada through the Ontario Genomics Institute (KCK), and CIHR Canada Research Chair (KCK). This study was supported in part by a studentship from the National Sciences and Engineering Research Council of Canada. Recruitment of clients and collection of samples was supported by Grant Number RO1AI050240 to JMM from the United States National Institute of Allergy and Infectious Diseases.

Disclaimer: The authors report that no conflicts of interest exist within this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIAID or the National Institutes of Health. The funding agencies had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

^* Address correspondence to Kevin C. Kain, Tropical Disease Unit, Eaton North 13-214, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4. E-mail: kevin.kain{at}uhn.on.ca

Authors’ addresses: Steven Perrault, Institute of Biomaterials and Biomedical Engineering, Room 450, Terrence Donnelly Centre for Cellular and Biomolecular Research, University of Toronto, 160 College Street, Toronto, Ontario, M5S 3E1. Jan Hajek, North York General Hospital, Infection Control Office GW-33, 4001 Leslie Street, Toronto, Ontario, M2K 1E1. Kathleen Zhong, McLaughlin Centre for Molecular Medicine, MaRS Centre, TMDT, 101 College Street, 14th Floor, Suite 701, Toronto, Ontario, M5G 1L7. Simon O. Owino, Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA 30602. Moses Sichangi, Kenya Medical Research Institute, Nairobi, Kenya, P.O. Box 54840, 00200. Geoffrey Smith, Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, University of Georgia, Athens, GA 30602. Ya Ping Shi, Division of Parasitic Diseases, Centers for Disease Control and Prevention, Mail Stop F-12, 4770 Buford Highway, Chamblee, GA 30341. Julie M. Moore, Department of Infectious Diseases and Center for Tropical and Emerging Global Diseases, Univesity of Georgia, Athens, GA 30602. Kevin C. Kain, Tropical Disease Unit, Eaton North 13-214, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Tel: 416-340-3535; Fax: 416-595-5826, E-mail: kevin.kain{at}uhn.on.ca.