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

Creators: Bulterys, Philip L.; Chao, Ann; Dalai, Sudeb C.; Zink, M. Christine; Dushimimana, Abel; Katzenstein, David; Saah, Alfred J.; Bulterys, Marc

Abstract

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.

Additional Information

© 2011 The American Society of Tropical Medicine and Hygiene. Received October 17, 2010. Accepted March 22, 2011. We gratefully acknowledge the Rwandan women whose participation made this study possible; the faculty and staff of the Centre Universitaire de Santé Publique (CUSP) in Butare, Rwanda; the staff of the health centers of CUSP, Sovu, Save, Rango, and Matyazo; and all the dedicated staff members of the National University of Rwanda–Johns Hopkins University AIDS Research Project in Butare, Rwanda from 1989 through 1994. We thank Homayoon Farzadegan for DNA PCR analysis. Ann Duerr contributed significantly to the initial phase of the cohort study and the malaria sub-study. Rich Respess's laboratory conducted the ultra-sensitive p24 antigen determinations. Paula Nawrocki, Andrea Imredy, and Ellen Taylor provided invaluable assistance to the study. Jules Kajugiro was responsible for collecting placentas soon after birth. We are especially grateful to the late Edmond Mugabo, the head laboratory technician responsible for processing of placenta specimens, and Jean-Baptiste Kurawige who was the primary physician responsible for neonatal and infant clinical examinations in the study. Edmond Mugabo and Jean- Baptiste Kurawige were among the many study staff and health care personnel who perished during the Rwanda genocide of April–June 1994. We thank Mary Glenn Fowler, Chin-Yih Ou, Lawrence Slutsker, and Rick Steketee for providing helpful comments on an earlier draft. We also thank Dmitri Petrov, members of the Petrov Lab at the Stanford University Department of Biology, and Allan Campbell for helpful discussion and comments on the manuscript. 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. Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

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