[afro-nets] Malaria's role in mother-to-child transmission of HIV

[Leela McCullough <leela@healthnet.org>]

Malaria's role in mother-to-child transmission of HIV in preg-
nancy
--------------------------------------------------------------

21 November 2005
http://www.mim.su.se/conference2005/eng/overview.html

MIM Pan-African Malaria Conferences

Malaria infections boost production of a substance that might
significantly increase HIV replication in the placenta. This in-
teraction could explain why mother-to-child transmission (MTCT)
of HIV in Yaounde increases following a rainy season, according
to new findings presented at this week's Fourth Multilateral
Initiative on Malaria (MIM) Pan-African Malaria Conference.

Laboratory tests have revealed that biological substances known
as "proinflammatory cytokines", such as TNF-alpha, which is
found in high levels in placentas infected with malaria, could
stimulate HIV replication in the placenta.

"Our research highlights the fact that placental malaria,
through the placental cytokine network, could play an important
role in mother-to-child HIV transmission in utero that has been
underestimated so far," said Anfumbom Kfutwah of the Pasteur
Center's virology laboratory. (Thursday, 3:10 p.m., Ebony Hall,
Parallel Session 26, Presentation 169)

He said scientists have been investigating a possible link be-
tween malaria and in utero HIV infections since a study con-
ducted in Yaounde Cameroon found that MTCTs peaked three months
after the rains peaked. Seasonal rains are known to bring an in-
crease in malaria infections by providing the ideal breeding en-
vironment for mosquitoes that carry the disease.

Kfutwah will be discussing a study currently ongoing by scien-
tists at Cameroon's Pasteur Center in collaboration with the In-
stitut Pasteur in Paris, France, on placentas collected from
women who were HIV positive and HIV negative, and with and with-
out malaria. This study is investigating the expression of pro-
inflammatory cytokines in relation to both pathogens.

Kfutwah said that further research needs to be done to better
understand how the malaria parasite induces the inflammatory re-
sponse that appears to interfere with the placenta's normal ac-
tion to protect the fetus from infections.

However, according to Kfutwah, solid evidence of a connection
between malaria and risk of fetal infection with HIV could
prompt health authorities to consider routinely testing pregnant
women in Cameroon and other African countries for both HIV and
malaria. Malaria treatment could then be initiated during preg-
nancy as a way to reduce the risks of infecting the fetus with
HIV.

The study by Kfutwah and his colleagues is one of several pres-
entations at the MIM conference that focus on the many chal-
lenges arising in a region where co-infections with both HIV,
which affects an estimated 29.4 million Africans, and malaria,
which sickens 500 million, are unfortunately quite common.

"Each disease by itself is a major problem both for the indi-
viduals affected and the health care system," said Andreas Hed-
dini, the MIM Secretariat coordinator. "But the fact that they
frequently occur together is a major complicating factor, and we
need more research to clarify how the two infections interact
and how to best treat co-infection. When you look at the many
discussions at MIM, it's clear that African scientists are aware
that we cannot look at HIV and malaria in isolation. We must in-
vestigate any interactions between what are arguably the two
biggest health threats facing the continent today."

Below are descriptions of other MIM presentations investigating
issues related to HIV and malaria co-infection:

* Modest Mulenga of the Tropical Diseases Research Centre in
Zambia will discuss a study on the use of intermittent preven-
tive treatment of malaria with sulfadoxine-pyrimethamine in HIV-
positive pregnant Zambian women. The World Health Organization
currently recommends the use of intermittent preventive treat-
ment (IPT) to reduce the burden of disease due to malaria during
pregnancy. Recent evidence suggests that more frequent monthly
dosing may be more effective for HIV-positive pregnant women.
(Monday, 4:15 p.m., Bubinga Hall, Parallel Session 1, Presenta-
tion 7)

* Stanley Mudambo of Zimbabwe Military Health Services will dis-
cuss research looking at the extent to which being HIV positive
causes severe complications and poor responses to malaria treat-
ment. (Tuesday, 1:00 p.m., Poster Session 9, Poster 217A)

* Tatfeng Mirabeau of Lahor Public Health and Research Center,
Nigeria, will discuss research showing that malaria can have
varying affects on people who are HIV positive depending on what
is known as their CD4 count, which is a measure of immune system
strength. People infected with HIV who had a low CD4 count--and
hence a more compromised immune system--had higher levels of
parasites in their blood (or parasitemia) compared to those with
a higher CD4 count. (Wednesday, 1:00 p.m., Poster Session 7,
Poster 131B)

* Noel Chisaka of WHO-AFRO's Southern Africa Inter-Country Ma-
laria Control Program will report on an analysis of malaria and
HIV co-infection in Southern Africa that calls for stronger col-
laboration between HIV and malaria programs. The study notes
that current treatment strategies for both diseases are failing
to adequately respond to issues that arise due to interactions
between HIV and malaria. (Tuesday, 1:00 p.m., Poster Session 9,
Poster 226A)

To provide coordinated international approach to fighting ma-
laria, the Roll Back Malaria Partnership (RBM)
(http://www.rollbackmalaria.org) was launched in 1998 by the
World Health Organization, the United Nations Children's Fund
(UNICEF), the United Nations Development Programme (UNDP) and
the World Bank. The Partnership now brings together governments
of countries affected by malaria, their bilateral and multilat-
eral development partners, the private sector, non-governmental
and community-based organizations, foundations, and research and
academic institutions around the common goal of halving the
global burden of malaria by 2010. World Malaria Report 2005
http://rbm.who.int/wmr2005/


The Multilateral Initiative on Malaria (MIM)
(http://www.mim.su.se/), launched in Dakar, Senegal in 1997, is
an international alliance of organizations and individuals seek-
ing to maximize the impact of scientific research against ma-
laria in Africa to ensure that research findings yield practical
health benefits. The MIM Secretariat was previously hosted for
3-years terms by the Wellcome Trust (UK) and the Fogarty Inter-
national Center at the National Institutes of Health (US). In
2003, the Secretariat moved to Stockholm, Sweden, where it is
hosted by the Karolinska Institute and Stockholm University.

http://www.rollbackmalaria.org/forumV/pressinfo.htm

You can also find information about malaria on the following
links: The PATH Malaria Vaccine Initiative:
http://www.malariavaccine.org , Medicines for Malaria Venture:
http://www.mmv.org and Special Programme for Research and Train-
ing in Tropical Diseases (TDR) World Health Organization:
http://www.who.int/tdr

The conference organizers and the Kaiser Family Foundation,
through its online news summary and webcasting service, kaiser-
network.org, are working together to bring online coverage of
the conference to those unable to attend. Kaisernetwork.org's
comprehensive online coverage will include webcasts and tran-
scripts of each day's plenary sessions and selected other ses-
sions, text summaries of select sessions, and interviews with
newsmakers. Slide presentations from select sessions will also
be available. Access the coverage at
http://www.kaisernetwork.org/malaria2005

Preeti Singh
MIM Pan-African Malaria Conferences
mailto:psingh@burnesscommunications.com
http://www.mim.su.se/conference2005/eng/overview.html


--
Leela McCullough, Ed.D.
Director of Information Services
SATELLIFE
30 California Street, Watertown, MA 02472, USA
Tel: +1-617-926-9400
Fax: +1-617-926-1212
mailto:leela@healthnet.org
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