Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

Nov 17, 2009Malaria journal

Placental malaria in HIV-positive and HIV-negative women taking anti-folate drugs in a high malaria area of Uganda

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Abstract

Placental malaria prevalence was 19% in HIV-infected women on trimethoprim-sulphamethoxazole and 26% in HIV-uninfected women on sulphadoxine-pyrimethamine.

HIV-infected women on trimethoprim-sulphamethoxazole did not have an increased risk of placental malaria compared to HIV-uninfected women on sulphadoxine-pyrimethamine after adjusting for various factors.
The rates of placental malaria detected by PCR were 19% in HIV-infected women and 26% in HIV-uninfected women.
Smear-positive placental malaria was associated with lower birth weight among all infants.
Primigravidae HIV-uninfected women were at a higher risk of placental malaria compared to multigravidae, a trend not observed in HIV-infected women.
The overall risk of placental malaria and low birth weight was noted to be high, indicating a need for improved interventions.

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BACKGROUND: HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS) and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP). TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women.

METHODS: This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP) in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR.

RESULTS: Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW). Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used.

CONCLUSION: Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a considerable impact on the burden of LBW in this population.

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Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda

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