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Clinical and Vaccine Immunology, April 2008, p. 617-621, Vol. 15, No. 4
1071-412X/08/$08.00+0     doi:10.1128/CVI.00378-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Impact of Human Immunodeficiency Virus Infection in Pregnant Women on Variant-Specific Immunity to Malaria

Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi,¹ Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi,² Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, United Kingdom,³ Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill, North Carolina,⁴ Department of Medicine, University of Melbourne, Royal Melbourne Hospital, Parkville Victoria, Australia⁵

Received 14 September 2007/ Returned for modification 15 October 2007/ Accepted 14 December 2007

Human immunodeficiency virus (HIV) increases susceptibility to Plasmodium falciparum infection, and this has most clearly been demonstrated in pregnant women. Variant surface antigens on the surfaces of erythrocytes infected with P. falciparum are major targets of protective immunity. We studied the impact of HIV infection on pregnant women's humoral immunity to variant surface antigens expressed by placental and pediatric isolates of P. falciparum. By flow cytometry, sera from HIV-infected women more frequently lacked antibodies to these antigens than sera from HIV-uninfected women. This difference was similar in magnitude for pediatric isolates (unadjusted odds ratio [OR] = 6.36; 95% confidence interval [CI] = 1.14, 35.32; P < 0.05) and placental isolates (unadjusted OR = 6.47; 95% CI = 0.75, 55.64; P < 0.10). We divided women into high and low responders on the basis of their antibody levels. After adjustment for CD4 count, maternal age, and gravidity, we found that HIV-infected women more frequently had low responses to both pediatric isolates (OR = 5.34; 95% CI = 1.23, 23.16; P = 0.025) and placental isolates (OR = 4.14; 95% CI = 1.71, 10.02; P = 0.002). The relative quantity of antibodies to both pediatric isolates (P = 0.035) and placental isolates (P = 0.005) was lower in HIV-infected women than in HIV-uninfected women. HIV infection has a broad impact on variant-specific immunity, which may explain the susceptibility of infected individuals to clinical malaria episodes.

Published ahead of print on 16 January 2008.