Objective: To investigate the effect of helminth and/or malaria infection on the risk of HIV infection in pregnant women and its transmission to their offspring.
Design: A retrospective cohort study of pregnant Kenyan women and their offspring from term, uncomplicated vaginal deliveries (n = 936) with a nested case-control study.
Methods: We determined the presence of HIV, malaria, schistosomiasis, lymphatic filariasis, and intestinal helminthes in mothers and tested for HIV antibodies in 12-24 month-old offspring of HIV-positive women. We related these findings to the presence of cord blood lymphocyte activation and cytokine production in response to helminth antigens.
Results: HIV-positive women (n = 83, 8.9% of all women tested) were 2-fold more likely to have peripheral blood and/or placental malaria (P < 0.025) and a 2.1-fold greater likelihood of lymphatic filariasis infection (P < 0.001) compared to location-and-parity matched HIV-negative women. Women with HIV and malaria tended to show an increased risk for mother-to-child-transmission (MTCT) of HIV, although this difference was not significant. MTCT of HIV, however, was significantly higher in women co-infected with one or more helminthes (48%) verses women without helminth infections (10%, P < 0.01; adjusted odds ratio, 7.3; 95% confidence interval, 2.4-33.7). This increased risk for MTCT of HIV correlated with cord blood lymphocytes production of interleukin-5/interleukin-13 in response to helminth antigens (P < 0.001).
Conclusion: Helminth co-infection is associated with increased risk for MTCT of HIV, possibly by a mechanism in which parasite antigens activates lymphocytes in utero. Treatment of helminthic infections during pregnancy may reduce the risk of MTCT of HIV.
Gallagher, Maureena; Malhotra, Indua; Mungai, Peter La,b; Wamachi, Alex Nc; Kioko, John Mb; Ouma, John Hd; Muchiri, Ericb; King, Christopher La,e
From the aCenter for Global Health and Diseases and Center for AIDS Research, Case Western Reserve University, Cleveland, OH, USA
bDivision of Vector Borne Diseases, Nairobi, Kenya
cKenyan Medical Research Institute, Kenya
dMaseno University, Maseno, Kenya
eDepartment of Veteran’s Affairs Medical Center, Cleveland, OH, USA.
Correspondence to C. L. King, Center for Global Health and Diseases, Case Western Reserve University, 2103 Cornell Rd, WRB Rm 4132, Cleveland, OH 44106-7286, USA. Tel: +1 216 368 4817; fax: +1 216 368 4825; e-mail: firstname.lastname@example.org
Citation: AIDS: Official Journal of the International AIDS Society, Nov. 4, 2005, – Volume 19 – Issue 16 – p 1849-1855
More information: Full text – The Effects of Maternal Helminth and Malaria Infections on Mother-to-Child HIV Transmission (PDF)