Incidence of malaria-related fever and morbidity due to Plasmodium falciparum among HIV1-infected pregnant women: a prospective cohort study in South Benin

Malaria Journal

Research

Djimon-Marcel Zannou¹  Jocelyn Akakpo¹  Aldric Afangnihoun²  Lucien Dossou-Gbété³  Komlan V Agossou⁴  Didier G Komongui⁵  Félix Atadokpédé⁶  Pierre-Marie Girard⁷  Michel Cot⁸  Lise Denoeud-Ndam⁸  Alexandre Duvignaud⁹ 

[1] Centre de Traitement Ambulatoire, Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Bénin;Faculté des Sciences de la Santé, Université d’Abomey-Calavi, Cotonou, Benin;Centre de Traitement Ambulatoire, Hôpital de zone de Suru Léré, Cotonou, Benin;Clinique Louis Pasteur, Cotonou, Bénin;Clinique Universitaire de Gynécologie et Obstétrique, Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, Bénin;Service de Gynécologie-Obstétrique, Hôpital de la Mère et de l’Enfant Lagune, Cotonou, Bénin;Service de Médecine Interne, Hôpital d’Instruction des Armées, Cotonou, Bénin;Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, France;Université Pierre et Marie Curie, Paris, France;UMR 216, Institut de Recherche pour le Développement, Paris, France;Université Paris Descartes, Paris, France;UMR 216, Institut de Recherche pour le Développement, Paris, France;Université Paris Descartes, Paris, France;Service de Médecine Tropicale, Clinical International Health, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France;

关键词: Malaria;    Pregnancy;    HIV;    Fever;    Incidence rate;    Attributable fraction;    Morbidity;   

DOI  :  10.1186/1475-2875-13-255

 received in 2014-04-17, accepted in 2014-06-30,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundMalaria and HIV are two major causes of morbidity and mortality among pregnant women in sub-Saharan Africa. Foetal and neonatal outcomes of this co-infection have been extensively studied. However, little is known about maternal morbidity due to clinical malaria in pregnancy, especially malaria-related fever, in the era of generalized access to antiretroviral therapy and anti-malarial preventive strategies.MethodsA cohort study was conducted in order to estimate the incidence rate and to determine the factors associated with malaria-related fever, as well as the maternal morbidity attributable to malaria in a high-transmission setting of South Benin among HIV-infected pregnant women. Four-hundred and thirty-two women who participated in a randomized trial testing strategies to prevent malaria in pregnancy were included and followed until delivery, with at least three scheduled visits during pregnancy. Confirmed malaria-related fever was defined as axillary temperature >37.5°C and a concomitant, positive, thick blood smear or rapid diagnostic test for Plasmodium falciparum. Suspected malaria-related fever was defined as an axillary temperature >37.5°C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation.ResultsIncidence rate for confirmed malaria-related fever was of 127.9 per 1,000 person-year (PY) (95% confidence interval (CI): 77.4-211.2). In multivariate analysis, CD4 lymphocytes (Relative Risk (RR) for a 50 cells/mm3 variation = 0.82; CI: 0.71-0.96), antiretroviral treatment started before inclusion (RR = 0.34; CI: 0.12-0.98) and history of symptomatic malaria in early pregnancy (RR = 7.10; CI: 2.35-22.49) were associated with the incidence of confirmed or suspected malaria-related fever. More than a half of participants with parasitaemia were symptomatic, with fever being the most common symptom. The crude fraction of febrile episodes attributable to malaria was estimated at 91%.ConclusionsThis work highlights that malaria is responsible for a substantial morbidity in HIV-infected pregnant women, with cellular immunodepression as a major determinant, and establishes the possible advantage offered by the early initiation of antiretroviral treatment.Trial registrationPACOME Study has been registered under the number NCT00970879.

【 授权许可】

CC BY   
© Duvignaud et al.; licensee BioMed Central Ltd. 2014