15th International AIDS Conference Bangkok, Thailand - July 11-16, 2004

Int Conf AIDS. 2004 Jul 11-16;15:Abstract No. LbOrC20

H Brahmbhatt¹, D Sullivan¹, F Askin², G Kigozi³, F Wabire-Mangen⁴, M Wawer⁵, R Gray^1
1Johns Hopkins School of Public Health, Baltimore, United States; ²Johns Hopkins Hospital, Baltimore, United States; ³Rakai Project, Rakai, Uganda; ⁴Makerere University, Kampala, Uganda; ⁵Columbia School of Public Health, New York, United States

BACKGROUND: Malaria has been associated with increased HIV-1 viral load, is more common in HIV+ individuals, and pregnant HIV+ women co-infected with malaria are more likely to have adverse birth outcomes. Our objective was to assess the effect of placental malaria (PM) and systemic maternal malaria (SM) infection on MTCT.

METHODS: A cohort of 300 HIV+ pregnant women were assessed in Rakai District, Uganda. Sociodemographic characteristics, and maternal HIV serostatus were assessed at 10-month intervals and infant HIV status (RNA-PCR) was evaluated by 6 weeks postpartum. Formalin fixed placentas, membranes and the umblical cords were examined with monoclonal antibody to P.Falciparum antigen (PfHRP II) to detect PM and SM was diagnosed by the Binax NOW® ICT Malaria Antigen Rapid Test. Based on band intensity, the positive Binax results were categorized as 1: low intensity 2: high intensity malaria infection. Multivariate log binomial regression modeling was used to estimate the rate ratio (RR) and 95% CI of MTCT associated with malaria.

RESULTS: The prevalence of PM was 34%. MTCT rates were significantly higher in women with PM versus women infected with HIV alone (29% vs10.3%, p=0.013), and the adjusted RR of MTCT associated with PM was 7.92 (CI:1.3-49.4), and with maternal HIV viral load was RR=9.0 (CI: 1.4-60.3). The prevalence of SM was 34%, and MTCT rates were significantly higher in women with malaria versus women infected with HIV alone (31.4% vs 8.4%, p=0.004), and the adjusted RR of MTCT was 4.0 (CI:0.9-18.2). MTCT rates were higher in the high versus low Binax band intensity (35.3% vs 27.8%, P<0.001).

CONCLUSIONS: Co-infection with PM or SM shows evidence of increasing the risk of MTCT. In addition to antiretroviral prophylaxis, provision of intensive malaria prophylaxis during pregnancy could reduce MTCT and more research is needed for effective malaria prevention in HIV+ mothers, as well as potential drug interactions between malaria and HIV treatments.

040711
LbOrC20

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