%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Duvignaud, A.
%A Denoeud, Lise
%A Akakpo, J.
%A Agossou, K. V.
%A Afangnihoun, A.
%A Komongui, D. G.
%A Atadokpede, F.
%A Dossou-Gbete, L.
%A Girard, P. M.
%A Zannou, D. M.
%A Cot, Michel
%T Incidence of malaria-related fever and morbidity due to Plasmodium falciparum among HIV1-infected pregnant women : a prospective cohort study in South Benin
%D 2014
%L fdi:010062350
%G ENG
%J Malaria Journal
%@ 1475-2875
%K Malaria ; Pregnancy ; HIV ; Fever ; Incidence rate ; Attributable fraction ; Morbidity
%K BENIN
%M ISI:000338894100002
%P art. 255
%R 10.1186/1475-2875-13-255
%U https://www.documentation.ird.fr/hor/fdi:010062350
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-10/010062350.pdf
%V 13
%W Horizon (IRD)
%X Background: Malaria 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. Methods: A 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 degrees 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 degrees C and the concomitant administration of an anti-malarial treatment in the absence of parasitological investigation. Results: Incidence 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/mm(3) 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%. Conclusions: This 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.
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