MATERNAL HIV-INFECTION AND INFANT-MORTALITY EVIDENCE FOR INCREASED MORTALITY DUE TO PLACENTAL MALARIA INFECTION

Objectives: To examine the relationship between maternal HIV infection , placental malaria infection, and infant mortality as a first step in investigating the possibility of increased vertical transmission of H IV due to placental malaria infection. Design: Retrospective analysis of data from a cohort study of mothers and infants in rural Malawi con ducted from 1987 to 1990. Methods: Pregnant women in Malawi were enrol led in a study examining chemoprophylaxis during pregnancy. At deliver y, placental malaria infection status was determined. Infants born int o this study were visited every 2 months for the first 2-3 years of li fe. Deaths were investigated using a standardized 'verbal autopsy' int erview. Maternal serum collected during pregnancy was tested for antib odies to HIV-1 by enzyme-linked immunosorbent assay with Western blot confirmation. Results: Overall, 138 (5.3%) of 2608 women in the study were HIV-1-seropositive. Infant mortality rates were 144 and 235 per 1 000 live births for children born to HIV-seronegative and HIV-seroposi tive women, respectively (P < 0.001). In a multivariate model, the odd s of dying during the post-neonatal period for an infant born to a mot her with both placental malaria and HIV infection was 4.5 times greate r than an infant born to a mother with only placental malaria, and bet ween 2.7 and 7.7 times greater (depending on birthweight) than an infa nt born to a mother with only HIV infection. Conclusions: This study s trongly suggests that exposure to both placental malaria infection and maternal HIV infection increases post-neonatal mortality beyond the i ndependent risk associated with exposure to either maternal HIV or pla cental malaria infection. If confirmed,,malaria chemoprophylaxis durin g pregnancy could decrease the impact of transmission of HIV from moth er to infant.