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

Gernard I. Msamanga Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Taha E. Taha Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Alicia M. Young Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Elizabeth R. Brown Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Irving F. Hoffman Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Jennifer S. Read Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Victor Mudenda Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Robert L. Goldenberg Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Usha Sharma Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Moses Sinkala Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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Wafaie W. Fawzi Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland; Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Biostatistics, University of Washington, Seattle, Washington; University of North Carolina Division of Infectious Diseases, Chapel Hill, North Carolina; Pediatric, Adolescent, and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland; Department of Pathology, University Teaching Hospital, Lusaka, Zambia; Department of Obstetrics and Gynecology, Drexel University, Philadelphia, Pennsylvania; Prevention Sciences Program, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland; Directorate of Health, Lusaka Urban District Health Management Team, Lusaka Zambia; Departments of Nutrition and Epidemiology, Harvard School of Public Health, Boston, Massachusetts

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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.

Author Notes

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@muhas.ac.tz.
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