The epidemiology of HIV seropositive malaria infected pregnant women in Akure Metropolis, Southwestern Nigeria

Abstract

Background: HIV increases the risks of malaria in pregnant women, while maternal human immunodeficiency virus (HIV) viral load also facilitates perinatal transmission to neonates. Malaria and HIV coinfection has been shown to exacerbate adverse pregnancy complications. Our study was designed to determine the HIV prevalence of pregnant women at an antenatal clinic in Akure in southwestern Nigeria, investigate the relationship between dual HIV and malaria infection and HIV viral load and CD4+ T cell counts. The study also estimated the risks of adverse pregnancy outcomes in a selected cohort of 74 pregnant women. Materials and Methods: We evaluated the HIV serostatus of 3,225 pregnant women, who attended the antenatal clinic between August 2012 and April 2013. A cohort of 74 pregnant women was selected for the investigation of the relationship between coinfection of HIV and malaria and HIV viral load and CD4+ cell counts. Their HIV status was determined during three trimesters of pregnancy by both HIV-1/2 strips and confirmatory enzyme-linked immunosorbent assay (ELISA) method. Malaria parasitemia was determined by Giemsa-stained thin and thick blood smears. CD4 cell count was by flow cytometry using the CyFlow Counter (Partec, Germany). Viral load estimated by Amplicor HIV-I monitor assay. Results: We found 3.53% prevalence of HIV serostatus among the 3,225 pregnant women who were screened. Forty-four of the 74 subjects were HIV positive and 30 were HIV negative controls. The results show HIV infection among the pregnant women reduced the CD4 cells from a mean of 750 cells/ml for HIV negative women to a mean of 363 cells/ml for HIV seropositive women. Additionally the presence of malaria more than doubled the HIV viral load from a mean of 7,270 ribonucleic acid (RNA) copies/ml for HIV positive women without malaria to 15,148 RNA copies/ml for HIV positive women with malaria. Conclusion: In this study, HIV infection significantly increased risk of acquiring malaria in pregnant women (odds ratio (OR) = 2.27). Dual HIV/malaria infections exacerbated adverse pregnancy outcomes