Clinical Malaria Diagnosis in Pregnancy in Relation to Early Perinatal Mother-to-Child-Transmission of HIV: A Prospective Cohort Study
Identifieur interne : 001960 ( Pmc/Corpus ); précédent : 001959; suivant : 001961Clinical Malaria Diagnosis in Pregnancy in Relation to Early Perinatal Mother-to-Child-Transmission of HIV: A Prospective Cohort Study
Auteurs : Ae Ezeamama ; C. Duggan ; Kp Manji ; D. Spiegelman ; E. Hertzmark ; Rj Bosch ; R. Kupka ; Jo Okuma ; R. Kisenge ; S. Aboud ; Ww FawziSource :
- HIV medicine [ 1464-2662 ] ; 2013.
Abstract
We prospectively investigated fever symptoms and maternal diagnosis of malaria in pregnancy (MIP) in relation to child HIV infection among 2,368 pregnant HIV-positive women and their infants, followed-up from pregnancy until birth and 6 weeks post-delivery in Tanzania.
Doctors clinically diagnosed and treated MIP and fever symptoms during prenatal healthcare. Child HIV status was determined via DNA-PCR. Multivariable logistic regression models estimated relative risks (RR) and 95% confidence intervals (CI) for HIV mother-to-child-transmission (MTCT) by 6th week of life.
Mean gestational age at enrollment was 22.2 weeks. During follow-up, 16.6% had ≥1 MIP diagnosis, 15.9% reported fever symptoms and 8.7% had both fever and MIP diagnosis. Eleven percent of HIV-exposed infants were HIV-positive by 6 weeks. The RR of HIV MTCT was statistically similar for infants whose mothers were ever vs. never clinical MIP diagnosed (RR=1.24, 95%CI:0.94–1.64), were diagnosed with 1 vs. 0 clinical MIP episode (RR=1.07;95%CI:0.77–1.48) and had ever vs. never reported fever symptoms (RR=1.04, 95%CI:0.78,1.38) in pregnancy. However, HIV MTCT risk increased by 29% (95%CI:4–58%) per MIP episode. Infants of women with ≥2 vs. 0 MIP diagnoses were 2.1 times more likely to be HIV infected by 6weeks old (95%CI:1.31–3.45).
Clinical MIP diagnosis, but not fevers, in HIV-positive pregnant women was associated with elevated risk of early HIV MTCT suggesting that malaria prevention and treatment in pregnant HIV-positive women may enhance the effectiveness of HIV prevention in MTCT programs in this setting. Future studies using laboratory confirmed malaria is needed to confirm this association.
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DOI: 10.1111/hiv.12111
PubMed: 24215465
PubMed Central: 4299572
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Duggan</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Division of Gastroenterology and Nutrition, Children's Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Manji, Kp" sort="Manji, Kp" uniqKey="Manji K" first="Kp" last="Manji">Kp Manji</name><affiliation><nlm:aff id="A4">Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Spiegelman, D" sort="Spiegelman, D" uniqKey="Spiegelman D" first="D" last="Spiegelman">D. Spiegelman</name><affiliation><nlm:aff id="A5">Department of Epidemiology, HSPH, Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Biostatistics, HSPH, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Hertzmark, E" sort="Hertzmark, E" uniqKey="Hertzmark E" first="E" last="Hertzmark">E. Hertzmark</name><affiliation><nlm:aff id="A5">Department of Epidemiology, HSPH, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Bosch, Rj" sort="Bosch, Rj" uniqKey="Bosch R" first="Rj" last="Bosch">Rj Bosch</name><affiliation><nlm:aff id="A6">Department of Biostatistics, HSPH, Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A7">Center for Biostatistics in AIDS Research, HSPH, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Kupka, R" sort="Kupka, R" uniqKey="Kupka R" first="R" last="Kupka">R. Kupka</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A8">United Nations Children’s Fund, Regional Office for West and Central Africa, Dakar, Senegal</nlm:aff></affiliation></author><author><name sortKey="Okuma, Jo" sort="Okuma, Jo" uniqKey="Okuma J" first="Jo" last="Okuma">Jo Okuma</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Kisenge, R" sort="Kisenge, R" uniqKey="Kisenge R" first="R" last="Kisenge">R. Kisenge</name><affiliation><nlm:aff id="A9">Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Aboud, S" sort="Aboud, S" uniqKey="Aboud S" first="S" last="Aboud">S. Aboud</name><affiliation><nlm:aff id="A9">Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation><affiliation><nlm:aff id="A10">Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Fawzi, Ww" sort="Fawzi, Ww" uniqKey="Fawzi W" first="Ww" last="Fawzi">Ww Fawzi</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A5">Department of Epidemiology, HSPH, Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A11">Department of Global Health and Population, HSPH, Boston, MA</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24215465</idno><idno type="pmc">4299572</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4299572</idno><idno type="RBID">PMC:4299572</idno><idno type="doi">10.1111/hiv.12111</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">001960</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001960</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical Malaria Diagnosis in Pregnancy in Relation to Early Perinatal Mother-to-Child-Transmission of HIV: A Prospective Cohort Study</title><author><name sortKey="Ezeamama, Ae" sort="Ezeamama, Ae" uniqKey="Ezeamama A" first="Ae" last="Ezeamama">Ae Ezeamama</name><affiliation><nlm:aff id="A1">Department of Epidemiology & Biostatistics, The University of Georgia, B.S. Miller Hall, Room 125, 101 Buck Rd, Athens, GA 30602, USA</nlm:aff></affiliation></author><author><name sortKey="Duggan, C" sort="Duggan, C" uniqKey="Duggan C" first="C" last="Duggan">C. Duggan</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Division of Gastroenterology and Nutrition, Children's Hospital, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Manji, Kp" sort="Manji, Kp" uniqKey="Manji K" first="Kp" last="Manji">Kp Manji</name><affiliation><nlm:aff id="A4">Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Spiegelman, D" sort="Spiegelman, D" uniqKey="Spiegelman D" first="D" last="Spiegelman">D. Spiegelman</name><affiliation><nlm:aff id="A5">Department of Epidemiology, HSPH, Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A6">Department of Biostatistics, HSPH, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Hertzmark, E" sort="Hertzmark, E" uniqKey="Hertzmark E" first="E" last="Hertzmark">E. Hertzmark</name><affiliation><nlm:aff id="A5">Department of Epidemiology, HSPH, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Bosch, Rj" sort="Bosch, Rj" uniqKey="Bosch R" first="Rj" last="Bosch">Rj Bosch</name><affiliation><nlm:aff id="A6">Department of Biostatistics, HSPH, Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A7">Center for Biostatistics in AIDS Research, HSPH, Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Kupka, R" sort="Kupka, R" uniqKey="Kupka R" first="R" last="Kupka">R. Kupka</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A8">United Nations Children’s Fund, Regional Office for West and Central Africa, Dakar, Senegal</nlm:aff></affiliation></author><author><name sortKey="Okuma, Jo" sort="Okuma, Jo" uniqKey="Okuma J" first="Jo" last="Okuma">Jo Okuma</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation></author><author><name sortKey="Kisenge, R" sort="Kisenge, R" uniqKey="Kisenge R" first="R" last="Kisenge">R. Kisenge</name><affiliation><nlm:aff id="A9">Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Aboud, S" sort="Aboud, S" uniqKey="Aboud S" first="S" last="Aboud">S. Aboud</name><affiliation><nlm:aff id="A9">Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation><affiliation><nlm:aff id="A10">Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Fawzi, Ww" sort="Fawzi, Ww" uniqKey="Fawzi W" first="Ww" last="Fawzi">Ww Fawzi</name><affiliation><nlm:aff id="A2">Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A5">Department of Epidemiology, HSPH, Boston, MA</nlm:aff></affiliation><affiliation><nlm:aff id="A11">Department of Global Health and Population, HSPH, Boston, MA</nlm:aff></affiliation></author></analytic><series><title level="j">HIV medicine</title><idno type="ISSN">1464-2662</idno><idno type="eISSN">1468-1293</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title><p id="P1">We prospectively investigated fever symptoms and maternal diagnosis of malaria in pregnancy (MIP) in relation to child HIV infection among 2,368 pregnant HIV-positive women and their infants, followed-up from pregnancy until birth and 6 weeks post-delivery in Tanzania.</p></sec><sec id="S2"><title>Methods</title><p id="P2">Doctors clinically diagnosed and treated MIP and fever symptoms during prenatal healthcare. Child HIV status was determined via DNA-PCR. Multivariable logistic regression models estimated relative risks (RR) and 95% confidence intervals (CI) for HIV mother-to-child-transmission (MTCT) by 6<sup>th</sup> week of life.</p></sec><sec id="S3"><title>Results</title><p id="P3">Mean gestational age at enrollment was 22.2 weeks. During follow-up, 16.6% had ≥1 MIP diagnosis, 15.9% reported fever symptoms and 8.7% had both fever and MIP diagnosis. Eleven percent of HIV-exposed infants were HIV-positive by 6 weeks. The RR of HIV MTCT was statistically similar for infants whose mothers were ever vs. never clinical MIP diagnosed (RR=1.24, 95%CI:0.94–1.64), were diagnosed with 1 vs. 0 clinical MIP episode (RR=1.07;95%CI:0.77–1.48) and had ever vs. never reported fever symptoms (RR=1.04, 95%CI:0.78,1.38) in pregnancy. However, HIV MTCT risk increased by 29% (95%CI:4–58%) per MIP episode. Infants of women with ≥2 vs. 0 MIP diagnoses were 2.1 times more likely to be HIV infected by 6weeks old (95%CI:1.31–3.45).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Clinical MIP diagnosis, but not fevers, in HIV-positive pregnant women was associated with elevated risk of early HIV MTCT suggesting that malaria prevention and treatment in pregnant HIV-positive women may enhance the effectiveness of HIV prevention in MTCT programs in this setting. Future studies using laboratory confirmed malaria is needed to confirm this association.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100897392</journal-id><journal-id journal-id-type="pubmed-jr-id">26808</journal-id><journal-id journal-id-type="nlm-ta">HIV Med</journal-id><journal-id journal-id-type="iso-abbrev">HIV Med.</journal-id><journal-title-group><journal-title>HIV medicine</journal-title></journal-title-group><issn pub-type="ppub">1464-2662</issn><issn pub-type="epub">1468-1293</issn></journal-meta><article-meta><article-id pub-id-type="pmid">24215465</article-id><article-id pub-id-type="pmc">4299572</article-id><article-id pub-id-type="doi">10.1111/hiv.12111</article-id><article-id pub-id-type="manuscript">NIHMS532759</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Clinical Malaria Diagnosis in Pregnancy in Relation to Early Perinatal Mother-to-Child-Transmission of HIV: A Prospective Cohort Study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ezeamama</surname><given-names>AE</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Duggan</surname><given-names>C</given-names></name><degrees>MD, MPH</degrees><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Manji</surname><given-names>KP</given-names></name><degrees>MBBS,MMED, MPH</degrees><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Spiegelman</surname><given-names>D</given-names></name><degrees>ScD</degrees><xref ref-type="aff" rid="A5">5</xref><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Hertzmark</surname><given-names>E</given-names></name><degrees>MS</degrees><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Bosch</surname><given-names>RJ</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A6">6</xref><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Kupka</surname><given-names>R</given-names></name><degrees>ScD</degrees><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Okuma</surname><given-names>JO</given-names></name><degrees>MS</degrees><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Kisenge</surname><given-names>R</given-names></name><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Aboud</surname><given-names>S</given-names></name><degrees>MD, MMED</degrees><xref ref-type="aff" rid="A9">9</xref><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Fawzi</surname><given-names>WW</given-names></name><degrees>MD, DrPH</degrees><xref ref-type="aff" rid="A2">2</xref><xref ref-type="aff" rid="A5">5</xref><xref ref-type="aff" rid="A11">11</xref></contrib></contrib-group><aff id="A1"><label>1</label>Department of Epidemiology & Biostatistics, The University of Georgia, B.S. Miller Hall, Room 125, 101 Buck Rd, Athens, GA 30602, USA</aff><aff id="A2"><label>2</label>Department of Nutrition, Harvard School of Public Health (HSPH), Boston, MA</aff><aff id="A3"><label>3</label>Division of Gastroenterology and Nutrition, Children's Hospital, Boston, MA</aff><aff id="A4"><label>4</label>Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</aff><aff id="A5"><label>5</label>Department of Epidemiology, HSPH, Boston, MA</aff><aff id="A6"><label>6</label>Department of Biostatistics, HSPH, Boston, MA</aff><aff id="A7"><label>7</label>Center for Biostatistics in AIDS Research, HSPH, Boston, MA</aff><aff id="A8"><label>8</label>United Nations Children’s Fund, Regional Office for West and Central Africa, Dakar, Senegal</aff><aff id="A9"><label>9</label>Department of Pediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</aff><aff id="A10"><label>10</label>Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania</aff><aff id="A11"><label>11</label>Department of Global Health and Population, HSPH, Boston, MA</aff><author-notes><corresp id="cor1"><bold>Corresponding Author:</bold> Amara E. Ezeamama, PhD. Department of Epidemiology & Biostatistics, The University of Georgia, B.S. Miller Hall, Room 125, 101 Buck Rd, Athens, GA 30602, USA; <email>aezeamam@uga.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>13</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>11</day><month>11</month><year>2013</year></pub-date><pub-date pub-type="ppub"><month>5</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>5</month><year>2015</year></pub-date><volume>15</volume><issue>5</issue><fpage>276</fpage><lpage>285</lpage><pmc-comment>elocation-id from pubmed: 10.1111/hiv.12111</pmc-comment>
<abstract><sec id="S1"><title>Objectives</title><p id="P1">We prospectively investigated fever symptoms and maternal diagnosis of malaria in pregnancy (MIP) in relation to child HIV infection among 2,368 pregnant HIV-positive women and their infants, followed-up from pregnancy until birth and 6 weeks post-delivery in Tanzania.</p></sec><sec id="S2"><title>Methods</title><p id="P2">Doctors clinically diagnosed and treated MIP and fever symptoms during prenatal healthcare. Child HIV status was determined via DNA-PCR. Multivariable logistic regression models estimated relative risks (RR) and 95% confidence intervals (CI) for HIV mother-to-child-transmission (MTCT) by 6<sup>th</sup> week of life.</p></sec><sec id="S3"><title>Results</title><p id="P3">Mean gestational age at enrollment was 22.2 weeks. During follow-up, 16.6% had ≥1 MIP diagnosis, 15.9% reported fever symptoms and 8.7% had both fever and MIP diagnosis. Eleven percent of HIV-exposed infants were HIV-positive by 6 weeks. The RR of HIV MTCT was statistically similar for infants whose mothers were ever vs. never clinical MIP diagnosed (RR=1.24, 95%CI:0.94–1.64), were diagnosed with 1 vs. 0 clinical MIP episode (RR=1.07;95%CI:0.77–1.48) and had ever vs. never reported fever symptoms (RR=1.04, 95%CI:0.78,1.38) in pregnancy. However, HIV MTCT risk increased by 29% (95%CI:4–58%) per MIP episode. Infants of women with ≥2 vs. 0 MIP diagnoses were 2.1 times more likely to be HIV infected by 6weeks old (95%CI:1.31–3.45).</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">Clinical MIP diagnosis, but not fevers, in HIV-positive pregnant women was associated with elevated risk of early HIV MTCT suggesting that malaria prevention and treatment in pregnant HIV-positive women may enhance the effectiveness of HIV prevention in MTCT programs in this setting. Future studies using laboratory confirmed malaria is needed to confirm this association.</p></sec></abstract><kwd-group><kwd>Co-infection</kwd><kwd>Malaria</kwd><kwd>AIDS</kwd><kwd>HIV mother-to-child-transmission</kwd><kwd>HIV-exposed Infant</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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