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The Effect of HIV Infection on the Risk, Frequency, and Intensity of Plasmodium falciparum Parasitemia in Primigravid and Multigravid Women in Malawi

Ella T. NkhomaDepartment of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, University of Melbourne, Parkville, Australia

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Natalie M. BowmanDepartment of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, University of Melbourne, Parkville, Australia

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Linda Kalilani-PhiriDepartment of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, University of Melbourne, Parkville, Australia

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Victor MwapasaDepartment of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, University of Melbourne, Parkville, Australia

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Stephen J. RogersonDepartment of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, University of Melbourne, Parkville, Australia

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Steven R. MeshnickDepartment of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, North Carolina; Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Medicine, University of Melbourne, Parkville, Australia

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Human immunodeficiency virus (HIV) is common in pregnant women in many malaria-endemic regions and may increase risk of placental parasitemia. Placental malaria is more common in primigravidae than multigravidae, but the relationship between HIV and malaria across gravidities is not well characterized. We recruited pregnant Malawian women during the second trimester and followed them until delivery. Parasitemia was assessed at enrollment, follow-up visits, and delivery, when placental blood was sampled. There was no difference in risk of parasitemia between HIV-positive and HIV-negative primigravidae. Among multigravidae, HIV-infected women had greater than twice the risk of parasitemia as HIV-uninfected women throughout follow-up. Human immunodeficiency virus was also associated with more frequent peripheral parasitemia in multigravidae but not primigravidae. Both HIV and primigravid status were independently associated with higher peripheral and placental parasite densities. Although risk of parasitemia is lower in multigravidae than primigravidae, the HIV effect on risk of malaria is more pronounced in multigravidae.

Author Notes

* Address correspondence to Natalie M. Bowman, Division of Infectious Diseases, CB#7030, Bioinformatics Building, 2nd floor, 130 Mason Farm Road, Chapel Hill, NC 27599. E-mail: nbowman@med.unc.edu

Financial support: This work was supported by Centers for Disease Control and Prevention Grant CDC/ASPH/ASTDR S1935-21/21. ETN was funded through the Kenan Fellowship at the University of North Carolina at Chapel Hill. NMB is supported by Ruth Kirschstein NRSA T32 715134 and NIH CTSA #UL1RR025747.

Authors' addresses: Ella T. Nkhoma, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, E-mail: ella.nkhoma@bms.com (Currently: Global Pharmacovigilance and Epidemiology, Bristol-Myers Squibb, Wallingford, CT). Natalie M. Bowman, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; Department of Medicine, Division of Infectious Diseases, University of North Carolina Hospitals, Chapel Hill, NC, E-mail: nbowman@med.unc.edu. Linda Kalilani-Phiri and Victor Mwapasa, Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi, E-mails: lkalilani@hotmail.com and vmwapasa@yahoo.com. Stephen J. Rogerson, Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia, E-mail: sroger@unimelb.edu.au. Steven R. Meshnick, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, E-mail: meshnick@email.unc.edu.

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