Malaria during pregnancy may increase mother-to-child HIV transmission

According to a report published in the November issue of the journal AIDS, babies born to women infected with both HIV and malaria are at a considerably greater risk of contracting the HIV virus.

The report states that HIV-infected pregnant women in Uganda’s Rakai district were almost three times more likely to transmit the HIV virus to their babies if the malaria parasite infected their placentas. The study found that of the 15 babies studied whose mothers had placental malaria, 40% became infected with HIV.

In January 2002, Heena Brahmbhatt, a PhD candidate at Johns Hopkins, studying mother-to-child transmission (MTCT) of HIV, came across a report that anti-malarial drugs could reduce HIV transmission to infants through their infected mothers’ breast milk. Intrigued by the possible impact of the drug,

Brahmbhatt studied the effects of malaria in data from the well-known Rakai study. The Rakai study, conducted in collaboration with several Ugandan research groups, evaluated MTCT in 746 HIV-positive pregnant women and their babies, in Uganda’s Rakai district, between 1994 and 1999.

Brahmbhatt found 93 cases where researchers had ascertained the baby’s HIV status and also preserved the placenta. Of the 15 babies whose mothers had placental malaria, she found that six (40%) became infected. In contrast, HIV spread to only 12 of the 78 infants (15%) whose mothers did not have malaria in their placentas.

Brahmbhatt, who agrees that the sample size of the study is small, and the findings inconclusive, nevertheless says the results are statistically significant, leading the authors of the Rakai study to conclude that trials are “urgently needed” to evaluate whether giving HIV-infected pregnant women malaria prophylaxis can help reduce HIV transmission.

“If our observations pan out, there may be a case for much more aggressive malaria suppression in HIV-infected women during pregnancy,” says Hopkins epidemiologist Ronald Gray, then Brahmbhatt’s advisor.