Clinical malaria diagnosis in pregnancy in relation to early perinatal mother‐to‐child transmission of HIV : a prospective cohort study

Objectives We prospectively investigated fever symptoms and maternal diagnosis of malaria in pregnancy ( MIP ) in relation to child HIV infection among 2368 pregnant HIV ‐positive women and their infants, followed up from pregnancy until 6 weeks post‐delivery in T anzania. Methods Doctors clinically diagnosed and treated MIP and fever symptoms during prenatal health care. Child HIV status was determined via DNA polymerase chain reaction ( PCR ). Multivariable logistic regression models were used to estimate relative risks ( RRs ) and 95% confidence intervals ( CIs ) for HIV mother‐to‐child transmission ( MTCT ) by the 6th week of life. Results Mean gestational age at enrolment was 22.2 weeks. During follow‐up, 16.6% of mothers had at least one MIP diagnosis, 15.9% reported fever symptoms and 8.7% had both fever and MIP diagnosis. Eleven per cent of HIV ‐exposed infants were HIV ‐positive by 6 weeks. The RR of HIV MTCT was statistically similar for infants whose mothers were ever vs. never clinically diagnosed with MIP ( RR 1.24; 95% CI 0.94–1.64), were diagnosed with one vs. no clinical MIP episodes ( RR 1.07; 95% CI 0.77–1.48) and had ever vs. never reported fever symptoms ( RR 1.04; 95% CI 0.78–1.38) in pregnancy. However, the HIV MTCT risk increased by 29% (95% CI 4–58%) per MIP episode. Infants of women with at least two vs. no MIP diagnoses were 2.1 times more likely to be HIV infected by 6 weeks old (95% CI 1.31–3.45). Conclusions Clinical MIP diagnosis, but not fevers, in HIV ‐positive pregnant women was associated with an elevated risk of early HIV MTCT , suggesting that malaria prevention and treatment in pregnant HIV ‐positive women may enhance the effectiveness of HIV prevention in MTCT programmes in this setting. Future studies using a laboratory‐confirmed diagnosis of malaria are needed to confirm this association.