Bloland P B, Wirima J J, Steketee R W, Chilima B, Hightower A, Breman J G
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
AIDS. 1995 Jul;9(7):721-6. doi: 10.1097/00002030-199507000-00009.
To examine the relationship between maternal HIV infection, placental malaria infection, and infant mortality as a first step in investigating the possibility of increased vertical transmission of HIV due to placental malaria infection.
Retrospective analysis of data from a cohort study of mothers and infants in rural Malawi conducted from 1987 to 1990.
Pregnant women in Malawi were enrolled in a study examining chemoprophylaxis during pregnancy. At delivery, placental malaria infection status was determined. Infants born into this study were visited every 2 months for the first 2-3 years of life. Deaths were investigated using a standardized 'verbal autopsy' interview. Maternal serum collected during pregnancy was tested for antibodies to HIV-1 by enzyme-linked immunosorbent assay with Western blot confirmation.
Overall, 138 (5.3%) of 2608 women in the study were HIV-1-seropositive. Infant mortality rates were 144 and 235 per 1000 live births for children born to HIV-seronegative and HIV-seropositive women, respectively (P < 0.001). In a multivariate model, the odds of dying during the post-neonatal period for an infant born to a mother with both placental malaria and HIV infection was 4.5 times greater than an infant born to a mother with only placental malaria, and between 2.7 and 7.7 times greater (depending on birthweight) than an infant born to a mother with only HIV infection.
This study strongly suggests that exposure to both placental malaria infection and maternal HIV infection increases post-neonatal mortality beyond the independent risk associated with exposure to either maternal HIV or placental malaria infection. If confirmed, malaria chemoprophylaxis during pregnancy could decrease the impact of transmission of HIV from mother to infant.
研究孕产妇感染艾滋病毒、胎盘疟疾感染与婴儿死亡率之间的关系，作为调查胎盘疟疾感染导致艾滋病毒垂直传播增加可能性的第一步。
对1987年至1990年在马拉维农村进行的一项母婴队列研究的数据进行回顾性分析。
马拉维的孕妇参与了一项关于孕期化学预防的研究。分娩时，确定胎盘疟疾感染状况。本研究中出生的婴儿在生命的头2至3年每2个月接受一次访视。使用标准化的“口头尸检”访谈对死亡情况进行调查。通过酶联免疫吸附测定法检测孕期采集的孕产妇血清中的HIV-1抗体，并通过蛋白质印迹法进行确认。
总体而言，该研究中的2608名女性中有138名（5.3%）HIV-1血清学呈阳性。艾滋病毒血清阴性和血清阳性女性所生孩子的婴儿死亡率分别为每1000例活产144例和235例（P<0.001）。在多变量模型中，母亲同时感染胎盘疟疾和艾滋病毒的婴儿在新生儿后期死亡的几率比母亲仅感染胎盘疟疾的婴儿高4.5倍，比母亲仅感染艾滋病毒的婴儿高2.7至7.7倍（取决于出生体重）。
本研究强烈表明，同时暴露于胎盘疟疾感染和孕产妇艾滋病毒感染会增加新生儿后期死亡率，超过仅暴露于孕产妇艾滋病毒或胎盘疟疾感染的独立风险。如果得到证实，孕期疟疾化学预防可降低艾滋病毒从母亲传播给婴儿的影响。
