乌干达高传播地区抗叶酸药物治疗的 HIV 感染和未感染妇女中的胎盘疟疾。
Placental malaria among HIV-infected and uninfected women receiving anti-folates in a high transmission area of Uganda.
机构信息
School of Medicine, University of California, San Francisco, 513 Parnassus Ave, San Francisco, CA 94131, USA.
出版信息
Malar J. 2009 Nov 14;8:254. doi: 10.1186/1475-2875-8-254.
BACKGROUND
HIV infection increases the risk of placental malaria, which is associated with poor maternal and infant outcomes. Recommendations in Uganda are for HIV-infected pregnant women to receive daily trimethoprim-sulphamethoxazole (TS) and HIV-uninfected women to receive intermittent sulphadoxine-pyrimethamine (SP). TS decreases the risk of malaria in HIV-infected adults and children but has not been evaluated among pregnant women.
METHODS
This was a cross sectional study comparing the prevalence of placental malaria between HIV-infected women prescribed TS and HIV-uninfected women prescribed intermittent preventive therapy with sulphadoxine-pyrimethamine (IPT-SP) in a high malaria transmission area in Uganda. Placental blood was evaluated for malaria using smear and PCR.
RESULTS
Placentas were obtained from 150 HIV-infected women on TS and 336 HIV-uninfected women on IPT-SP. The proportion of HIV-infected and HIV-uninfected women with placental malaria was 19% vs. 26% for those positive by PCR and 6% vs. 9% for those positive by smear, respectively. Among all infants, smear+ placental malaria was most predictive of low birth weight (LBW). Primigravidae were at higher risk than multigravidae of having placental malaria among HIV-uninfected, but not HIV-infected, women. Adjusting for gravidity, age, and season at the time of delivery, HIV-infected women on TS were not at increased risk for placental malaria compared to HIV-uninfected women on IPT-SP, regardless of the definition used.
CONCLUSION
Prevalence of placental malaria was similar in HIV-infected women on TS and HIV-uninfected women on IPT-SP. Nonetheless, while nearly all of the women in this study were prescribed anti-folates, the overall risk of placental malaria and LBW was unacceptably high. The population attributable risk of placental malaria on LBW was substantial, suggesting that future interventions that further diminish the risk of placental malaria may have a considerable impact on the burden of LBW in this population.
背景
HIV 感染会增加胎盘疟疾的风险，而胎盘疟疾与母婴不良结局有关。乌干达的建议是，HIV 感染的孕妇应每天服用甲氧苄啶-磺胺甲噁唑（TS），而未感染 HIV 的孕妇则应间歇性服用磺胺多辛-乙胺嘧啶（SP）。TS 可降低 HIV 感染的成人和儿童患疟疾的风险，但尚未在孕妇中进行评估。
方法
这是一项横断面研究，比较了在乌干达高疟疾传播地区，接受 TS 治疗的 HIV 感染妇女和接受间歇性预防治疗的磺胺多辛-乙胺嘧啶（IPT-SP）的 HIV 未感染妇女的胎盘疟疾患病率。使用涂片和 PCR 评估胎盘血液中的疟疾。
结果
从 150 名接受 TS 治疗的 HIV 感染妇女和 336 名接受 IPT-SP 治疗的 HIV 未感染妇女中获得了胎盘。PCR 阳性的 HIV 感染和 HIV 未感染妇女中胎盘疟疾的比例分别为 19%和 26%，而涂片阳性的比例分别为 6%和 9%。在所有婴儿中，涂片阳性的胎盘疟疾与低出生体重（LBW）的关系最密切。与 HIV 未感染的多胎妇女相比，初产妇发生胎盘疟疾的风险更高，但在 HIV 感染妇女中并非如此。调整孕次、年龄和分娩时的季节后，TS 治疗的 HIV 感染妇女与 IPT-SP 治疗的 HIV 未感染妇女相比，无论采用哪种定义，发生胎盘疟疾的风险均无增加。
结论
TS 治疗的 HIV 感染妇女和 IPT-SP 治疗的 HIV 未感染妇女的胎盘疟疾患病率相似。尽管本研究中的大多数妇女都开了抗叶酸药物，但胎盘疟疾和 LBW 的总体风险仍然高得不可接受。胎盘疟疾对 LBW 的人群归因风险很大，这表明未来进一步降低胎盘疟疾风险的干预措施可能会对该人群 LBW 的负担产生重大影响。
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