Effect of HIV and malaria chemo-prophylaxis on multiplicity of plasmodium falciparum infections in pregnant women in western Kenya
Otecko, Newton Otieno
MetadataShow full item record
Malaria during pregnancy and human immunodeficiency virus (HIV) continue to be enormous public health challenges in sub-Saharan Africa. Sulfadoxine- pyrimethamine (SP) and cotrimoxazole (CTX) that are currently recommended for prevention of malaria and opportunistic infections (OIs) in HIV infected persons respectively, are both sulphur-based drugs with similar modes of action. Owing to the risk of adverse reactions, SP is contraindicated in HIV -infected women who are already on daily CTX. Natural immunity against malaria during pregnancy is acquired in a gradual gravidity-dependent manner and is dependent on the diversity of parasites to which an individual is exposed, multiplicity of infections (Mal), and the period of exposure. Studies have shown that the gravidity- dependent acquisition of immunity is affected by both SP intake and HIV infection. However, there is limited information on the effect of drugs used during pregnancy and HIV infection on MOls. This study therefore sought to investigate the effect of drugs used to prevent both malaria during pregnancy and OIs, and HIV-infection on the MOls of Plasmodium falciparum in 332 peripheral and placental samples collected between August 2008 and June 2009 in a retrospective study conducted in Siaya and Bondo district hospitals. Deoxyribonucleic acid (DNA) extracted from dried blood spots (DBSs) by Chelex method was analysed by nested polymerase chain reaction (PCR) based on the highly polymorphic merozoite surface proteins (MSP-l and MSP-2). In this study, MSP-l Mal was higher in peripheral than placental samples, while MSP-2 MOl was more predominant in placental samples. These differences were, however, not statistically significant. HIV infection and high parasite densities, 1001-9999 parasites/uL and ~1 0000 parasites/ul., were associated with significantly high MOls (p = 0.036, p = 0.023 and p = 0.002, respectively). Similarly, primigravidae was associated with significantly high MOls (p = 0.043). There was a trend towards high MOls in women presenting with anaemia and fever, however, this was not statistically significant (p = 0.085 and p = 0.090 respectively). Overall, there was no association between drug intake during pregnancy and MOls. These findings suggest that first pregnancy and high parasite densities may be independent risk factors for high MOls in pregnant women living in malaria endemic areas. The role of SP and/or daily CTX on P. falciparum MOls in pregnant women requires further evaluations using a larger sample size and alternative molecular markers such as microsatellite markers in order to fully elucidate the effect of drugs on MOls.