Gallagher Maureen, Malhotra Indu, Mungai Peter L, Wamachi Alex N, Kioko John M, Ouma John H, Muchiri Eric, King Christopher L
Center for Global Health and Diseases and Center for AIDS Research, Case Western Reserve University, Cleveland, OH 44106-7286, USA.
AIDS. 2005 Nov 4;19(16):1849-55. doi: 10.1097/01.aids.0000189846.90946.5d.
To investigate the effect of helminth and/or malaria infection on the risk of HIV infection in pregnant women and its transmission to their offspring.
A retrospective cohort study of pregnant Kenyan women and their offspring from term, uncomplicated vaginal deliveries (n = 936) with a nested case-control study.
We determined the presence of HIV, malaria, schistosomiasis, lymphatic filariasis, and intestinal helminthes in mothers and tested for HIV antibodies in 12-24 month-old offspring of HIV-positive women. We related these findings to the presence of cord blood lymphocyte activation and cytokine production in response to helminth antigens.
HIV-positive women (n = 83, 8.9% of all women tested) were 2-fold more likely to have peripheral blood and/or placental malaria (P < 0.025) and a 2.1-fold greater likelihood of lymphatic filariasis infection (P < 0.001) compared to location-and-parity matched HIV-negative women. Women with HIV and malaria tended to show an increased risk for mother-to-child-transmission (MTCT) of HIV, although this difference was not significant. MTCT of HIV, however, was significantly higher in women co-infected with one or more helminthes (48%) verses women without helminth infections (10%, P < 0.01; adjusted odds ratio, 7.3; 95% confidence interval, 2.4-33.7). This increased risk for MTCT of HIV correlated with cord blood lymphocytes production of interleukin-5/interleukin-13 in response to helminth antigens (P < 0.001).
Helminth co-infection is associated with increased risk for MTCT of HIV, possibly by a mechanism in which parasite antigens activates lymphocytes in utero. Treatment of helminthic infections during pregnancy may reduce the risk of MTCT of HIV.
探讨蠕虫和/或疟疾感染对孕妇感染艾滋病毒风险及其母婴传播的影响。
对肯尼亚足月顺产且无并发症的孕妇及其后代进行回顾性队列研究（n = 936），并进行巢式病例对照研究。
我们检测了母亲体内艾滋病毒、疟疾、血吸虫病、淋巴丝虫病和肠道蠕虫的感染情况，并对艾滋病毒阳性女性12至24个月大的后代进行了艾滋病毒抗体检测。我们将这些结果与脐带血淋巴细胞激活情况以及对蠕虫抗原产生的细胞因子进行关联分析。
与地理位置和生育次数匹配的艾滋病毒阴性女性相比，艾滋病毒阳性女性（n = 83，占所有检测女性的8.9%）外周血和/或胎盘感染疟疾的可能性高出2倍（P < 0.025），淋巴丝虫病感染的可能性高出2.1倍（P < 0.001）。感染艾滋病毒和疟疾的女性母婴传播艾滋病毒的风险往往会增加，尽管这种差异并不显著。然而，与未感染蠕虫的女性（10%，P < 0.01；调整后的优势比为7.3；95%置信区间为2.4 - 33.7）相比，同时感染一种或多种蠕虫的女性艾滋病毒母婴传播率显著更高（48%）。艾滋病毒母婴传播风险的增加与脐带血淋巴细胞对蠕虫抗原产生白细胞介素-5/白细胞介素-13相关（P < 0.001）。
蠕虫合并感染与艾滋病毒母婴传播风险增加有关，可能是通过寄生虫抗原在子宫内激活淋巴细胞的机制。孕期治疗蠕虫感染可能会降低艾滋病毒母婴传播的风险。
