Human immunodeficiency virus seropositivity and malaria as risk factors for third-trimester anemia in asymptomatic pregnant women in western Kenya

To assess risk factors for anemia in late pregnancy, we studied healthy pre gnant women with a singleton uncomplicated pregnancy of greater than or equ al to 32 weeks attending the prenatal clinic in the Provincial Hospital in Kisumu, Kenya. Between June 1996 and December 1998, 4,608 pregnant women ha d a blood sample collected for hemoglobin (Hb) measurement, malaria smear, and testing for human immunodeficiency virus (HIV). The mean standard devia tion of Hb was 9.58 +/- 1.8 g/dL; 21% had malaria in their blood; and 25% o f the women were HIV seropositive. Plasmodium falciparum parasitemia was mo re common among HIV-seropositive women in all gravidities compared with HIV -seronegative women (risk ratio, 1.71; 95% confidence interval, 1.53-1.92). In a multivariate analysis, for primi- and secundigravidae women, the fact ors malaria, belonging to the Luo tribe, and HIV seropositivity were signif icantly associated with any anemia (Hb < 11 g/dL), and HIV seropositivity a nd documented fever were associated with severe anemia (Hb < 7 g/dL). In wo men of higher gravidities, HIV seropositivity was the only statistically si gnificant factor associated with any anemia or with severe anemia. Asymptom atic HIV seropositivity is an important risk factor to be considered in the differential diagnosis of maternal anemia, independent of P. falciparum pa rasitemia.