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

Philip L. Bulterys UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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Ann Chao UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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Sudeb C. Dalai UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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M. Christine Zink UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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Abel Dushimimana UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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David Katzenstein UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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Alfred J. Saah UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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Marc Bulterys UCLA/Caltech Medical Scientist Training Program, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California; Department of Biology, Stanford University, Stanford, California; National University of Rwanda- Johns Hopkins University AIDS Research Project (1989–1994), School of Medicine, Butare, Rwanda; Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, California; Division of Epidemiology, UC-Berkeley School of Public Health, Berkeley, California; Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Centre Universitaire de Santé Publique, National University of Rwanda School of Medicine, Butare, Rwanda; Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland

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DOI:
https://doi.org/10.4269/ajtmh.2011.10-0589
Volume/Issue:
Volume 85: Issue 2
Page(s):
202–206
Restricted access
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We conducted a nested case-control study of placental malaria (PM) and mother-to-child transmission (MTCT) of human immunodeficiency virus-1 (HIV-1) within a prospective cohort of 627 mother-infant pairs followed from October 1989 until April 1994 in rural Rwanda. Sixty stored placentas were examined for PM and other placental pathology, comparing 20 HIV-infected mother-infant (perinatal transmitter) pairs, 20 HIV-uninfected pairs, and 20 HIV-infected mothers who did not transmit to their infant perinatally. Of 60 placentas examined, 45% showed evidence of PM. Placental malaria was associated with increased risk of MTCT of HIV-1 (adjusted odds ratio [aOR] = 6.3; 95% confidence interval [CI] = 1.4–29.1), especially among primigravidae (aOR = 12.0; 95% CI = 1.0–150; P < 0.05). Before antiretroviral therapy or prophylaxis, PM was associated with early infant HIV infection among rural Rwandan women living in a hyper-endemic malaria region. Primigravidae, among whom malaria tends to be most severe, may be at higher risk.

Author Notes

*Address correspondence to Philip L. Bulterys, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095. E-mail: bulterys@ucla.edu

Financial support: This study was supported by grants from the National Institute of Child Health and Human Development (HD22496 and HD25785) and from the World AIDS Foundation (114-96024). PLB is supported by the UCLA/Caltech Medical Scientist Training Program (MSTP) and the Paul and Daisy Soros Fellowships for New Americans.

Authors' addresses: Philip L. Bulterys, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, E-mail: bulterys@ucla.edu. Ann Chao and Marc Bulterys, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, E-mails: annchao@bellsouth.net and zbe2@cdc.gov. Sudeb C. Dalai and David Katzenstein, Department of Infectious Diseases, School of Medicine, Stanford University, Stanford, CA, E-mails: sdalai@stanford.edu and davidkk@stanford.edu. M. Christine Zink, Department of Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, MD, E-mail: mzink1@jhmi.edu. Abel Dushimimana, World Health Organization, Africa Regional Office, Brazzaville, Congo, E-mail: dushimimana@yahoo.fr. Alfred J. Saah, Merck Research Laboratories, Blue Bell, PA, E-mail: alfred_saah@merck.com.

Copyright:
©The American Society of Tropical Medicine and Hygiene 2011
Received:
17 Oct 2010
|
Accepted:
22 Mar 2011
|
Published Online:
01 Aug 2011
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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