IMPAIRMENT OF A PREGNANT WOMANS ACQUIRED ABILITY TO LIMIT PLASMODIUM-FALCIPARUM BY INFECTION WITH HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1

In Africa, the human immunodeficiency virus (HIV) is the most serious emerging infection and Plasmodium falciparum malaria is one of the mos t prevalent infectious diseases. Both infections have serious conseque nces in pregnant women, their fetuses, and infants. We examined the as sociation between HIV and P. falciparum in pregnant women enrolled in a malaria chemoprophylaxis study in rural Malawi. Pregnant women (n = 2,946) were enrolled at their first antenatal clinic visit (mean 5.6 m onths of pregnancy), placed on one of three chloroquine regimens, and followed through delivery. Plasmodium falciparum parasitemia was measu red at enrollment, monthly thereafter, at delivery, and 2-6 months pos tpartum; placental and newborn (umbilical cord blood) infection was me asured for hospital-delivered infants. Serum collected during pregnanc y was tested for antibodies tb HIV by enzyme-linked immunoassay with W estern blot confirmation. Parasitemia was detected in 46% of 2,946 wom en at enrollment and 19.1% at delivery; HIV seroprevalence was 5.5%. T he prevalence and geometric mean density (GMPD) of parasitemia at enro llment and at delivery were higher in HIV-seropositive(+) than in HIV- seronegative(-) women (at enrollment: 57% prevalence and a GMPD of 1,5 58 parasites/mm(3) versus 44% and 670/mm(3) respectively; P < 0.0001; and at delivery: 35% and 1,589/mm(3) versus 18% and 373/mm(3); P < 0.0 005). Placental infection rates were higher in HIV(+) compared with HI V(-) women (38% versus 23%; P < 0.0005). This association was stronges t in multigravidas. Compared with infants born to HIV(-) women, newbor ns born to HIV(+) women had higher rates of umbilical cord blood paras itemia. Both HIV(+) and HIV(-) women had similar rates of parasitemia 2-6 months postpartum. The HIV infection diminishes a pregnant woman's capacity to control P. falciparum parasitemia and placental and newbo rn infection, the major determinants of the impact of P. falciparum on fetal growth and infant survival.