By Tim Parsons
School of Public Health

Placental malaria infection during pregnancy significantly increases the risk of mother-to-child transmission of HIV, according to researchers at the Johns Hopkins Bloomberg School of Public Health. Their study of HIV-positive women living in Rakia, Uganda, found that the mother-to-child HIV transmission rates were 40 percent among women with placental malaria compared with 15.4 percent for women without malaria. The researchers believe that interventions to prevent malaria during pregnancy could potentially reduce mother-to-child transmission of HIV. The study, which is the first to look at the effects of placental malaria in mother-to-child HIV transmission, is published in the November issue of the scientific journal AIDS.

"Our findings show that co-infection with placental malaria and HIV during pregnancy significantly increases the risk of HIV transmission from mother to newborn. Preventing and treating malaria during pregnancy could be a beneficial and cost-effective means of reducing the transmission of HIV from mother to newborn," said Heena Brahmbhatt, lead author of the study and an assistant scientist with the Department of Population and Family Health Sciences at the School of Public Health. Brahmbhatt added that HIV and malaria are among the most prevalent infectious diseases in sub-Saharan Africa.

For the study, Brahmbhatt and her colleagues followed 746 HIV-positive mothers and their infants living in Rakai between 1994 and 1999. The participants were enrolled from a larger study of maternal and infant health and the treatment of sexually transmitted diseases during pregnancy. Malaria parasite infection was measured in the mother's placenta and was found to be more common in HIV-positive women than in those who were HIV-negative. HIV transmission from mother to child occurred 20 percent of the time among all of the participants but was substantially higher if the mother had placental malaria.

"These findings could have potential public health relevance because interventions to prevent placental malaria during pregnancy might reduce the risk of HIV transmission from mother to child and this could augment current approaches using antiretroviral drugs. Randomized trials of intensive malaria control in HIV-positive women are urgently needed," Brahmbhatt said.

The study was funded by the Johns Hopkins Malaria Research Institute.

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