Preventing Malaria in HIV-Infected Pregnant Women

Abstract

Efforts to curb or eliminate malaria incidence in areas with a high prevalence of human immunodeficiency virus (HIV) face many challenges, chief among which are inconsistent access to proven interventions and limited resources of prevention and control programs. These challenges are compounded by the fact that HIV and malaria interact synergistically, with HIV increasing the risk and severity of clinical malaria and malaria increasing the viral load and hence transmission of HIV [1]. Coinfection with malaria and HIV is of special concern for pregnant women. In sub-Saharan Africa, where more than three-quarters of the world's HIV-infected women reside, an estimated 30 million women are at risk of acquiring Plasmodium falciparum malaria every year [2]. Coinfection during pregnancy imperils both maternal and newborn health outcomes. HIV-infected pregnant women are at increased risk of parasitemia and clinical malaria throughout their pregnancy, and this increased risk is particularly apparent in multiparous women who in the setting of HIV infection do not develop the parity-dependent antimalarial immunity typically observed in areas of high malaria transmission. Coinfected women are also at increased risk of developing severe anemia and placental malaria. Placental malaria and HIV coinfection has been shown to predispose to higher rates of neonatal mortality, preterm delivery, low birth weight, and, in some settings, increased risk of mother-to-child transmission of HIV [3, 4], highlighting the critical need for evaluation and delivery of effective prevention strategies.

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