Special Symposium on Malaria Prevention in Pregnancy
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


In Africa, the human immunodeficiency virus (HIV) is the most serious emerging infection and malaria is one of the most prevalent infectious diseases. Both infections have serious consequences in pregnant women, their fetuses, and infants. We examined the association between HIV and in pregnant women enrolled in a malaria chemoprophylaxis study in rural Malawi. Pregnant women (n = 2,946) were enrolled at their first antenatal clinic visit (mean 5.6 months of pregnancy), placed on one of three chloroquine regimens, and followed through delivery. parasitemia was measured at enrollment, monthly thereafter, at delivery, and 2–6 months postpartum; placental and newborn (umbilical cord blood) infection was measured for hospital-delivered infants. Serum collected during pregnancy was tested for antibodies to HIV by enzyme-linked immunoassay with Western blot confirmation. Parasitemia was detected in 46% of 2,946 women at enrollment and 19.1% at delivery; HIV seroprevalence was 5.5%. The prevalence and geometric mean density (GMPD) of parasitemia at enrollment and at delivery were higher in HIV-seropositive(+) than in HlV-seronegative(−) women (at enrollment: 57% prevalence and a GMPD of 1,558 parasites/mm versus 44% and 670/mm, respectively; 0.0001; and at delivery: 35% and 1,589/mm versus 18% and 373/mm; 0.0005). Placental infection rates were higher in HIV(+) compared with HIV(−) women (38% versus 23%; 0.0005). This association was strongest in multigravidas. Compared with infants born to HIV(−) women, newborns born to HIV(+) women had higher rates of umbilical cord blood parasitemia. Both HIV(+) and HIV(−) women had similar rates of parasitemia 2–6 months postpartum. The HIV infection diminishes a pregnant woman's capacity to control parasitemia and placental and newborn infection, the major determinants of the impact of on fetal growth and infant survival.


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