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Research Article Open access CC BY 3.0

Malarial Morbidity and Postnatal HIV Infection in Breastfeeding HIV-exposed Infants

Amara E. Ezeamama, Christopher Duggan, Donna Spiegelman, Ellen Hertzmark, Ronald J. Bosch, Karim P. Manji, Roland Kupka, Melanie W. Lo, James O. Okuma, Rodrick Kisenge, Said Aboud, Wafaie W. Fawzi

International Journal of TROPICAL DISEASE & Health · pp. 18–30 · Published 9 Oct 2013

10.9734/IJTDH/2014/6085

Abstract

Background: For at-risk HIV-negative individuals, whether malarial morbidity increases the likelihood of HIV infection when exposed is unknown. Hence, we investigate the malaria-associated risk of postnatal HIV infection in 1804 breastfeeding infants of HIV-positive women from Dar es Salaam, Tanzania. Methods: Six-week-old HIV-negative infants were followed until breastfeeding cessation or postnatal HIV infection. HIV-1 status was determined by a DNA PCR test. Malarial morbidity was diagnosed by physicians using a combination of clinical symptoms and laboratory tests. For analytic purposes, malaria was distinguished by diagnostic specificity as: (1) clinical; (2) probable, where laboratory testing is requested for parasitemia; and (3) blood smear-confirmed. Hazard ratios (HR) and 95% confidence intervals (CI) for the risk of HIV infection were estimated from multivariate Cox regression models. Results: Mean follow-up duration was 6.2 months (standard deviation=2.4 months), during which 91 new HIV infections developed and clinical malaria was diagnosed in 594(32.3%) children, including 283 (15.5%) probable and 80(4.4%) confirmed malaria episodes. Infants ever diagnosed with clinical and probable malaria were at 73% (95%CI:1.11 - 2.69) and 100% (95%CI:1.17-3.42) higher risk of postnatal HIV infection, respectively. This risk increased by 39% (95%CI: 1.08-1.80) and 59% (95%CI: 1.00-2.32), respectively, per episode increment in clinical and probable malarial; however, confirmed malaria was not significantly associated with HIV incidence (HR=2.09; 95%CI: 0.74 - 5.91). Conclusion: We found positive associations between child malarial infection and postnatal HIV infection among breastfeeding HIV-negative children of HIV-positive women. These findings suggest that malaria prevention in such infants may decrease the risk of HIV mother-to-child-transmission. However, specific future studies using laboratory-confirmed malaria in HIV-negative but HIV at risk populations are needed to substantiate these findings.

HIV/AIDS malaria co-infection children hiv incidence breastfeeding Sub-Saharan Africa

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Cited by 2

Clinical malaria diagnosis in pregnancy in relation to early perinatal mother‐to‐child transmission of HIV: a prospective cohort study

AE Ezeamama, C Duggan, KP Manji · HIV Medicine · 2013

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