| dc.description.abstract | Human Immunodeficiency Virus (HIV) and malaria pose major public health problems due
to their high overlapping global geographic distribution and resultant high rates of coinfection.
Sub-Saharan Africa bears the greatest burden of HIV (67%) and malaria (86%)
infections. Malaria and HIV-1 are co-endemic in Kenya with more than 70% of the
population at risk of acquiring malaria and 5.6% of the population living with HIV. Kisumu
County in Western Kenya has a high prevalence of HIV (19.3%) and malaria (38%)
compared to other parts of the country. HIV and malaria modulate an infant’s immune
response in-utero. In co-infected individuals, HIV related immunosuppression may lead to
impaired control of parasitemia and increased risk of developing severe malaria. Moreover,
severe malaria is thought to strongly predispose infants to other infectious diseases. However,
the link between malarial infections and episodes of severe bacterial infections has not been
investigated in this region of Kisumu Kenya. This longitudinal prospective case-control study
examined the association between malarial infections and incidences of severe bacterial
infections in infants with and without in-utero exposure to HIV. HIV Exposed Uninfected
(HEU) refers to infants with in-utero exposure to HIV while HIV Unexposed Uninfected
(HUU) refers to infants without in-utero exposure to HIV. Both groups were HIV negative. A
total of 121 infants (HEU, n=63 and HUU, n=58) were recruited from the Chulaimbo subcounty
Hospital in Kisumu County. Blood was collected by a certified phlebotomist from
these infants at the ages of 6, 9, 12, 15, 18, 21, and 24 months. DNA was extracted from
whole blood samples and Plasmodium falciparum parasitemia determined by Real-time PCR.
The incidence of severe clinical infections was determined based on clinical data collected by
the study team at all scheduled follow-up visits and voluntary sick visits. Chi-Square tests
were used to compare the proportions of Pf positive samples in the HEU and the HUU infants
and to determine differences in proportions of severe clinical infections at individual time
points. Risk and odd ratios were used to determine the association between severe clinical
infections and malaria in HIV exposed and unexposed infants. Student t-test was used to
determine the difference in means at birth and 6-months of the anthropometric measures;
weight (birth, p=0.1449; 6-months, p=0.5325), height (birth, p=0.0236; 6-months, p=0.1831)
and head circumference (birth, p=0.6415; 6-months, p=0.1710) as well as the mean total
malaria diagnosis (p=0.0029) between the two exposure groups. HUU infants had a greater
proportion of “any-malaria” (p=0.0004) and total number of malaria episodes per infant
(p=0.0029) than HEU infants. Maternal HIV status was not related to the outcome of severe
clinical events (p=0.1295), with HEU infants having a lower but not statistically significant
risk and odds of bacterial related severe clinical events outcome, than their HUU
counterparts: diarrhea with severe dehydration (p=0.7817), severe pneumonia (p=0.3317) and
severe malaria (p=0.0954) as determined by Pearson’s Chi-square test between the two
exposure groups. Thus, the data suggests that the likelihood of severe clinical bacterial
infections is greater in HUU infants compared to HEU infants. The findings of this study may
be attributed to the positive effects of healthcare interventions such as Cotrimoxazole
prophylaxis treatment, insecticide treated bed net use, adherence to chemoprevention regimen
by HEU infants and exclusive breastfeeding. This calls for a keen focus on HUU infants who
are presumed to be healthier but seem to bear a greater burden of malaria infections and
severe-bacterial clinical events. These findings are important for healthcare provision to both
HEU and HUU infants residing in HIV and malaria co-endemic areas. | en_US |
