Date of Award

9-29-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Elijah Paintsil, MD

Abstract

EFFECT OF MALARIA ON HIV VIRAL LOAD AND MATERNAL OUTCOMES IN HIVPOSITIVE PREGNANT WOMEN OF ACCRA, GHANA Jana Halfon, Elizabeth Levey, Margaret Lartey, Richard Adanu, Michael Ntimi, Larysa Aleksenko, Kwamena Sagoe, Patrick Kumi, Michael Cappello, and Elijah Paintsil (Sponsored by Elijah Paintsil, Yale School of Medicine, through the Doris Duke Charitable Foundation) HIV-1 positive pregnant women co-infected with malaria face increased risk of Mother-to-childtransmission (MTCT) of HIV. Placental malaria has been implicated, whether through an increase in placental or peripheral HIV viral load or a disruption of placental architecture. But the mechanism is not well understood. There are no studies in West Africa, where HIV and malaria co-infection is prevalent. We determined whether reported malaria infection in HIV-1 positive pregnant women affects either peripheral or placental HIV viral load. Establishing how malaria affects HIV-positive pregnancies in this population is of public health significance. 130 HIV-positive pregnant women in their third trimester were recruited at the Korle-Bu Teaching Hospital in Accra, Ghana from 2007 to 2009 and followed prospectively until delivery. Of 130 recruited, 65 delivered at Korle-Bu. HIV-1 RNA concentration of peripheral and placental blood samples were measured using Amplicor HIV-1 Monitor version 1.5. Giemsa-stained peripheral and placental thick blood films were analyzed for malaria parasitemia. Periumbilical and peripheral full-thickness placental tissue biopsies were fixed, stained with Giemsa and H&E, and assessed by a pathologist blinded to subject data. The overall mean peripheral and placental HIV-1 viral loads were 5045 copies/ml (SD 16014) and 3389 copies/ml (SD 10679), respectively. No significant effect was seen between subjects reporting and not reporting malaria during pregnancy. Significance was seen in the effect of 2 or more doses of intermittent preventative treatment on reducing incidence of malaria (p<0.0001) and in the effect of combination antiretroviral therapy in reducing HIV viral load compared to single-dose NVP at delivery (p=0.05). The low mean HIV-1 viral loads in this population may be responsible for the low rate MTCT at Korle-Bu (0.3 percent, unpublished data). The low rate of transmission warrants further research on the local placental factors influencing transmission. Aggressive antimalarial and antiretroviral therapies are having a significant impact on reducing risk of developing clinical malaria and risks of MTCT of HIV, but better widespread access to care is still needed.

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