Abstract:
Malaria, helminthiasis and HIV are widespread infectious diseases in developing
countries with heavy toll on pregnant women. Cases of co-infection exist due to
similar environmental and human factors of transmission. The risk factors, control
measures and pathology of these diseases on mother and child have been extensively
studied but there is limited data on maternal iron status and cytokine profile, which are
key determinants of a successful pregnancy. The aim of this study was to evaluate the
interactions of these diseases on maternal iron status and peripheral blood cytokines.
Blood and stool samples were collected from apparently healthy 18-45 years old
pregnant women recruited in different trimesters between August, 2011 and March,
2015. They were registered at the antenatal (n=490) and HIV clinics (n=217) of
Adeoyo Maternity Hospital and Agbongbon Primary Healthcare Centre in Ibadan, Oyo
State. Pretested questionnaires were administered for personal and socio-demographic
details. Malaria parasitemia in Giemsa-stained thick blood films was examined
microscopically. Stool samples were screened for helminths using Kato-Katz method.
Absolute CD4 counts of HIV infected patients were determined by flow cytometry.
Packed Cell Volume (PCV) was also determined. Ferritin and transferrin
concentrations and cytokine levels (TNF-α, IFN-γ, IL-1α, IL-2, IL-4, IL-6, IL-10, IL 12p70, IL-13 and IL-17) in serum were determined using ELISA. Iron level was
determined by atomic absorption spectrophotometry. Data were analysed using
descriptive statistics, logistic regression and Mann-Whitney U test at α0.05.
The mean age of the patients was 28.6±5.4 years old and majority (54.4%) were petty
traders. Prevalence of infections were: 10.8% (malaria), 9.6% (helminths), 1.6%
(malaria/helminths), 24% (malaria/HIV), 2.8% (helminths/HIV) and 0.5%
(malaria/helminths/HIV). Co-infection of malaria and helminths had the lowest
malaria parasite density (470 parasites/µL of blood) but the highest Ascaris egg count
(1,959epg). The CD4 count of co-infection of HIV and malaria was <350 cells/mm3
.
Residents of houses without toilet facilities (n=38) were 4.5 times more likely to be
infected with helminths (OR=4.45, CI=1.71-11.55). There were 57.6% cases of low
PCV (29.3% - 31.0%) and PCV values were significantly lower in those with malaria,
HIV and co-infection of both relative to the uninfected. Concentrations of ferritin in
the second trimester were significantly higher in single infection groups relative to the
uninfected (19.50 ng/mL) with highest median values in malaria (121.07 ng/mL). In
ii
second and third trimesters, median transferrin levels were significantly reduced in
HIV (2,689.84 µg/mL; 2,528.72 µg/mL, respectively) and its co-infection with malaria
(2,177.33 µg/mL; 2,865.75 µg/mL, respectively) relative to the uninfected (6,753.88
µg/mL; 6,542.88 µg/mL, respectively). Significant elevation occurred in IFN-γ in
those with Plasmodium only relative to those with Plasmodium and helminth co infection. In second and third trimesters, co-infection of malaria and HIV showed
significant elevations in their cytokine profiles relative to their occurrences as single
infections. Median serum iron concentration was significantly lower in malaria (0.3
mg/L) compared with the uninfected (1.24 mg/L).
Malaria co-infection with HIV predisposes to haemolytic anaemia and distortions in
blood cytokines. However, helminth protects in co-infection with malaria or HIV with
no profound impairment of the cytokine profiles.
