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Placental Malaria and Mother-to-Child Transmission of Human Immunodeficiency Virus-1

There are few studies of the association between placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1), and the results of published studies are inconsistent. To determine the association between PM and MTCT of HIV-1, we performed a secondary analysis of data from a clinical trial of antibiotics to reduce chorioamnionitis. Data regarding 1,662 HIV-1–infected women with live born singleton and first-born twin infants with information regarding PM and infant HIV-1 infection status at birth were analyzed. At the time of the study, women did not have access to antiretroviral drugs for treatment of acquired immunodeficiency syndrome but had received nevirapine prophylaxis to reduce the risk of MTCT of HIV-1. Placental malaria was not associated with the infant HIV-1 infection status at birth (P = 0.67). Adjustment for maternal plasma viral load and CD4+ cell count did not change these results (odds ratio = 1.06, 95% confidence interval = 0.51–2.20, P = 0.87). Placental malaria was more likely to be related to HIV-1 infection at birth among women with low viral load at baseline (P for interaction = 0.08). In conclusion, PM was not associated with infant HIV-1 infection status at birth. The interaction of maternal plasma viral load, PM, and MTCT of HIV-1 warrants further studies.

Received December 29, 2007. Accepted for publication November 6, 2008.

Acknowledgments: We thank Julia Finkelstein and Saurabh Mehta (Harvard School of Public Health, Boston, Massachusetts), Anthony Mwatha (SCHARP, Seattle, Washington), and Steve Meshnick and Susan Fiscus (School of Public Health, University of North Carolina) for critical reviews of earlier versions of this article.

Financial support: This study was supported by the HIV Network for Prevention Trials (HIVNET) and sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, and the Department of Health and Human Services through contract #N01-AI-35173 with Family Health International; contract #N01-AI-45200 with Fred Hutchinson Cancer Research Center; and subcontract #N01-AI-35173-117/412 with Johns Hopkins University. This work was also sponsored by the NIAID, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute on Drug Abuse, the National Institute of Mental Health, and the Office of AIDS Research at the National Institutes of Health, the U.S. Department of Health and Human Services, Harvard University (U01-AI-48006), Johns Hopkins University (U01-AI-48005), and the University of Alabama at Birmingham (U01-AI-47972). Nevirapine (Viramune; Boehringer Ingelheim GmbH, Ingelheim, Germany) was provided by Boehringer Ingelheim Pharmaceuticals, Incorporated.

Disclaimer: The assertions and conclusions presented in this article do not necessarily reflect those of the funding agencies and participating institutions.

^* Address correspondence to Gernard I. Msamanga, Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, PO Box 65001, Dar es Salaam, Tanzania. E-mail: gmsamanga{at}muhas.ac.tz

Authors’ addresses: Gernard I. Msamanga, Department of Community Health, Muhimbili University College of Health Sciences, United Nations Road, PO Box 65001, Dar es Salaam, Tanzania, E-mail: gmsamanga{at}muhas.ac.tz. Taha E. Taha, Johns Hopkins University Bloomberg School of Hygiene and Public Health, 615 North Wolfe Street, Room E 6011, Baltimore, MD 21205, E-mail: ttaha{at}jhsph.edu. Alicia M. Young, Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, E-mail: alicia{at}scharp.org. Elizabeth R. Brown, University of Washington, Department of Biostatistics Box 357232, Seattle, WA 98195, E-mail: ebrown{at}scharp.org. Irving F. Hoffman, University of North Carolina Division of Infectious Diseases, Chapel Hill, NC 27599, E-mail: hoffmani{at}med.unc.edu. Jennifer S. Read, Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health, Executive Building, Room 4B11C, 6100 Executive Boulevard, MSC 7510, Bethesda, MD 20892-7510, E-mail: jennifer_read{at}nih.gov. Victor Mudenda, Department of Pathology, University Teaching Hospital, Lusaka, Zambia, E-mail: mudenda2003{at}yahoo.co.uk. Robert L. Goldenberg, Department of Obstetrics and Gynecology, Drexel University College of Medicine, 245 North 15th Street, 17th Floor, Room 17113, Philadelphia, PA 19102, E-mail: rgoldenb{at}drexelmed.edu. Usha Sharma, Division of AIDS, National Institute of Allergy and Infectious Diseases, 6700 B Rockledge Drive, Bethesda, MD 20892, E-mail: usharma{at}niaid.nih.gov. Moses Sinkala, Directorate of Health, Lusaka Urban District Health Management Team, 9965 Makanta Close, Fairview Lusaka, Zambia, E-mail: moses{at}cidrcz.org. Wafaie W. Fawzi, Department of Nutrition, Third Floor, Room 329, Harvard School of Public Health, 665 Huntington Avenue, Boston MA 02115, E-mail: mina{at}hsph.harvard.edu.

Reprint requests: Gernard I. Msamanga, Department of Community Health, Muhimbili University of Health and Allied Sciences, United Nations Road, PO Box 65001, Dar es Salaam, Tanzania, E-mail: gmsamanga{at}muhas.ac.tz.