Prevalence of the co-infection of Malaria and HIV virus in a case-cohort study of women in Anambra, Nigeria

Abstract

The daily increasing incidence of malaria and human immunodeficiency virus (HIV) co-infection and 
associated poor maternal and obstetrical outcomes among pregnant women in the malarious zone of 
Anambra east, southeast Nigeria, and the paucity of laboratory-based data on the deadly duo, necessitated 
this study on the prevalence of the co-infection in a case-cohort study of 450 women (15 to 45 years) from 
whom placental and peripheral blood samples were collected. Screening for HIV antibodies was by the 
DETERMINE and GENIE–II, confirmed at 95% confidence interval. Pregnancy screening was by human 
chorionic gonadotropin (HCG) one step pregnancy test strip. Placental malaria was determine by Pooled
biopsy; peripheral malaria, from maternal venous blood. Giemsa stain of thin and thick blood smears were 
assayed; results were confirmed by dipstick rapid test. Anaemia estimation was by packed cell volume. 
Population attributable fraction-associated co-infection was 62% (P-value, 0.019). Acute malaria (+++) was 
highest among dually infected multigravidas (53%) (P-value, 0.0672), and multiple infections highest in 
second trimester (mean parasite density, 3,471.1 ± 101.0 parasites/µl), with preponderance in the 25 to 29 
age bracket (4,720.51 ± 110.3 parasites/µl). Gravidity-associated co-infection was prevalent among the 
multigravidas, with mean parasite density of 19,224.1 ± 136.0 parasites/µl. Placental malaria was a significant 
risk factor for mortality and morbidity (P < 0.01), and maternal anaemia which is the single most important 
adverse pregnancy outcome. Significance of abortion, pre-term delivery and low infant birth weights as 
serious adverse maternal outcomes were further established in the study.