Malaria during pregnancy and foetal haematological status in Blantyre, Malawi

BACKGROUND: Although maternal anaemia often stems from malaria infection during pregnancy, its effects on foetal haemoglobin levels are not straightforward. Lower-than-expected cord haemoglobin values in malarious versus non-malarious regions were noted by one review, which hypothesized they resulted from foetal immune activation to maternal malaria. This study addressed this idea by examining cord haemoglobin levels in relation to maternal malaria, anaemia, and markers of foetal immune activation. METHODS: Cord haemoglobin levels were examined in 32 malaria-infected and 58 uninfected women in Blantyre, Malawi, in relation to maternal haemoglobin levels, malaria status, and markers of foetal haematological status, hypoxia, and inflammation, including TNF-α, TGF-β, and ferritin. All women were HIV-negative. RESULTS: Although malaria was associated with a reduction in maternal haemoglobin (10.8 g/dL vs. 12.1 g/dL, p < 0.001), no reduction in cord haemoglobin and no significant relationship between maternal and cord haemoglobin levels were found. Cord blood markers of haematological and hypoxic statuses did not differ between malaria-infected and uninfected women. Maternal malaria was associated with decreased TGF-β and increased cord ferritin, the latter of which was positively correlated with parasitaemia (r = 0.474, p = 0.009). Increased cord ferritin was associated with significantly decreased birth weight and gestational length, although maternal and cord haemoglobin levels and malaria status had no effect on birth outcome. CONCLUSION: In this population, cord haemoglobin levels were protected from the effect of maternal malaria. However, decreased TGF-β and elevated ferritin levels in cord blood suggest foetal immune activation to maternal malaria, which may help explain poor birth outcomes

Sexual Dysfunction among HIV Patients: Three Case Reports and Review of Literature

Global efforts in addressing the HIV/AIDS epidemic have focused on preventing new infections, reduction of viral loads through treatment and care and support for the patients. Hardly any attention has been given to their quality of life in particular sexual health and functioning. There is a growing body of literature indicating high prevalence of sexual problems amongst HIV-infected individuals, whose mechanisms remain unclear. This may affect individuals’ quality of life, interpersonal relationships and HIV treatment. The sub-Saharan Africa (SSA) region is the epicentre of the HIV epidemic, majority of the patients being young (< 30 years old) and in long-term heterosexual relationships. With increased life expectancy due to expanded access to HAART, the prevalence and potential impact of sexual dysfunction are certain to be significant. There is urgent need for appropriate research on sexual experiences and functioning amongst HIV patients in SSA and appropriate interventions to address them. Current efforts to link HIV/AIDS and sexual and reproductive health and rights (SRHR) and proposals to make SRH services integrated and comprehensive provide are a good starting point. However SRHR policies, strategic plans and programmes should be reviewed to ensure inclusion of sexual health.Les efforts mondiaux dans la lutte contre l&apos;épidémie de VIH/SIDA ont mis l&apos;accent sur la prévention des nouvelles infections, la réduction de la charge virale par le traitement, les soins et le soutien des patients. Pratiquement aucune attention n&apos;a été accordée à leur qualité de vie, surtout la santé sexuelle et le fonctionnement. Il y a un nombre croissant de documentation indiquant une forte prévalence des problèmes sexuels entre les individus infectés par le VIH, dont les mécanismes restent peu clairs. Ceci peut affecter la qualité de vie des individus, les relations interpersonnelles et le traitement du VIH. La région de l&apos;Afrique subsaharienne (ASS) est l&apos;épicentre de l&apos;épidémie de VIH, la majorité des patients étant jeunes (< 30 ans) et dans les relations hétérosexuelles à long terme. Avec l&apos;augmentation de l&apos;espérance de vie à cause d’un accès élargi aux TARTHA, la prévalence et l&apos;impact potentiel de la dysfonction sexuelle sont certains d’être importantes. Il y a un besoin urgent d’une recherche appropriée sur les expériences sexuelles et le fonctionnement chez les patients séropositifs en Afrique subsaharienne et des interventions appropriées pour y remédier. Les efforts actuels pour relier le VIH/SIDA et la santé sexuelle et de la reproduction et les droits (SSRD) et des propositions pour rendre les services de santé sexuelle et de la reproduction SSR intégrée et globale représentent un bon point de départ. Cependant, les politiques de SSRD, les plans stratégiques et les programmes doivent être revus pour assurer l&apos;intégration de la santé sexuelle

Evaluation of the OptiMAL Rapid Antigen Test and Species-Specific PCR To Detect Placental Plasmodium falciparum Infection at Delivery

During pregnancy, Plasmodium falciparum infection of the placenta frequently occurs in the absence of parasites in peripheral blood. We investigated the abilities of the OptiMAL rapid immunochromatographic strip test for P. falciparum lactate dehydrogenase and species-specific PCR performed on peripheral blood to detect placental infection or malaria-associated low birth weight. Of 509 Malawian women screened by microscopy, 76 had malaria infection. Among these 509 women, the frequency of peripheral blood parasitemia was low. The OptiMAL test gave positive results in 37 of 171 women tested (one of whom had placental but not peripheral blood parasitemia) and had sensitivities of 71% for peripheral parasitemia and 38% for placental parasitemia compared to the microscopy values. The specificity for peripheral parasitemia was 94%. In 135 women, PCR had sensitivities of 94% for peripheral blood malaria detected by microscopy and 72% for placental infection. In samples examined by PCR, the prevalence of malaria in peripheral blood increased from 26.7% by microscopy to 51.9%. Women with placental malaria and women with malaria in peripheral blood samples by microscopy or OptiMAL testing, but not women with malaria detected only by PCR, had lower-birth-weight babies than did women without malaria by these criteria. Positive results by PCR in the absence of microscopic parasitemia were not associated with low birth weight. Neither OptiMAL nor PCR testing of peripheral blood is adequately sensitive to detect all placental malaria infection, but a positive result by OptiMAL testing identifies women with a high proportion of low-birth-weight babies

Placental Tumor Necrosis Factor Alpha but Not Gamma Interferon Is Associated with Placental Malaria and Low Birth Weight in Malawian Women

Malaria in pregnancy predisposes to maternal anemia and low birth weight (LBW). We examined the possible roles of the cytokines tumor necrosis factor alpha (TNF-α) and gamma interferon (IFN-γ) in these adverse outcomes. We measured cytokine concentrations in placental, peripheral, and cord blood plasma in relation to malaria parasitemia and placental monocyte accumulation in 276 Malawian women. Maternal hemoglobin concentration, human immunodeficiency virus status, and infant birth weight were determined. Concentrations of TNF-α in placental blood were correlated with densities of Plasmodium falciparum-infected erythrocytes (P < 0.0001) and of intervillous monocyte infiltrates (P < 0.0001) on placental histology. Peripheral blood TNF-α concentrations were relatively low and were weakly associated with malaria. TNF-α concentrations were higher in placental blood, where they were strongly associated with malaria. Placental plasma TNF-α levels were higher in women who had LBW babies (P = 0.0027), women with febrile symptoms (P < 0.0001), and teenage mothers (P = 0.04) than in other women. The presence of TNF-α in cord blood was not associated with malaria infection. IFN-γ levels were infrequently elevated, and elevated IFN-γ levels were not associated with poor pregnancy outcomes. Placental production of TNF-α, but not of IFN-γ, may be implicated in impaired fetal growth in Malawian women

Host response to malaria during pregnancy: Placental monocyte recruitment is associated with elevated beta chemokine expression

Malaria during pregnancy is associated with poor birth outcomes, particularly low birth weight. Recently, monocyte infiltration into the placental intervillous space has been identified as a key risk factor for low birth weight. However, the malaria-induced chemokines involved in recruiting and activating placental monocytes have not been identified. In this study, we determined which chemokines are elevated during placental malaria and the association between chemokine expression and placental monocyte infiltration. Placental malaria infection was associated with elevations in mRNA expression of three beta chemokines, macrophage-inflammatory protein 1 (MIP-1) alpha (CCL3), monocyte chemoattractant protein 1 (MCP-1; CCL2), and I-309 (CCL1), and one alpha chemokine, IL-8 (CXCL8); all correlated with monocyte density in the placental intervillous space. Placental plasma concentrations of MIP-1alpha and IL-8 were increased in women with placental malaria and were associated with placental monocyte infiltration. By immunohistochemistry, we localized placental chemokine production in malaria-infected placentas: some but not all hemozoin-laden maternal macrophages produced MIP-1beta and MCP-1, and fetal stromal cells produced MCP-1. In sum, local placental production of chemokines is increased in malaria, and may be an important trigger for monocyte accumulation in the placenta