The Burden of Co-Infection With Human Immunodeficiency Virus Type 1 and Malaria in Pregnant Women in Sub-Saharan Africa

Abstract

In sub-Saharan Africa, human immunodeficiency virus (HIV) and malaria are among the leading causes of morbidity during pregnancy. We reviewed available information collected since the first report 15 years ago that HIV impaired the ability of pregnant women to control malaria parasitemia. Results from 11 studies showed that HIV-infected women experienced consistently more peripheral and placental malaria (summary relative risk = 1.58 and 1.66, respectively), higher parasite densities, and more febrile illnesses, severe anemia, and adverse birth outcomes than HIV-uninfected women, particularly in multigravidae. Thus, HIV alters the typical gravidity-specific pattern of malaria risk by shifting the burden from primarily primigravidae and secundigravidae to all pregnant women. The proportional increase of malaria during pregnancy attributable to HIV was estimated to be 5.5% and 18.8% for populations with HIV prevalences of 10% and 40%, respectively. Maternal malaria was associated with a two-fold higher HIV-1 viral concentrations. Three studies investigating whether placental malaria increased mother-to-child HIV-1 transmission showed conflicting results, possibly reflecting a complex balance between placental malarial immune responses and stimulation of HIV-1 viral replication. Further investigations of interactions between antiretroviral drugs, prophylaxis with cotrimoxazole, and antimalarial drugs in pregnant women are urgently needed. Although much has been learned in the past 15 years about the interaction between malaria and HIV-1 during pregnancy, many issues still require further information to improve our understanding. There is a clear need to strengthen the deployment of existing malaria and HIV prevention and intervention measures for pregnant women.

Prevalence and Risk Factors of Anaemia Among Pregnant women in Nigeria

“…However, logistic regression analysis showed that anaemia was significantly and independently related to HIV infection. This finding corroborates previous reports [33,34].…”

Mother‐to‐child transmission of HIV‐1: association with malaria prevention, anaemia and placental malaria*

“…The detrimental effects of this interaction may be especially relevant during pregnancy, with adverse outcomes for both the mother and the infant [2,3].…”

“…Several studies have reported a transient increase in peripheral HIV RNA viral load in adults and pregnant women with peripheral malaria which is resolved with effective antimalarial therapy [13][14][15][16]. As maternal HIV RNA viral load is a recognized risk factor for MTCT [6,7,11], it has been suggested that malaria, by increasing the replication of HIV, may increase the risk of MTCT [2,6]. However, studies assessing the impact of placental malaria (PM) on MTCT have produced conflicting results, suggesting either that PM could increase MTCT or that low-density PM parasitaemia could decrease MTCT [6,7,17,18].…”

Seizing the Big Missed Opportunity: Linking HIV and Maternity Care Services in Sub-Saharan Africa

“…In some high HIV prevalence locations, HIV-related TB is now the leading cause of maternal mortality. [6][7][8][9][10][11] The evidence highlights the inter-dependent nature of problems relating to HIV, HIV co-infections and pregnancy. It also points to the importance of integrated responses.…”