CONCISE COMMUNICATION Immunity to Placental Malaria. II. Placental Antigen±Speci®c Cytokine Responses Are Impaired in Human Immunode®ciency Virus±Infected Women

An association was demonstrated recently between elevated in vitro production of interferon (IFN)±g by intervillous blood mononuclear cells (IVBMCs) and protection against placental malaria (PM). Because human immunode®ciency virus (HIV)±infected pregnant women have increased susceptibility to PM, loss of the IFN-g response in these women may impair their ability to control PM. Measurement of cytokines in culture supernatants by ELISA revealed that IFN-g responses by HIV-positive IVBMCs were impaired, especially after malarial an-tigen stimulation. Interleukin (IL)±4 and IL-10 responses also were reduced in HIV-positive persons, the latter more so in HIV-positive, PM-positive persons. In contrast, tumor necrosis factor±a production generally was enhanced in PM-positive and HIV-positive persons. Over-all, cytokine production was reduced in HIV-positive persons with CD4 T cell counts!500/ mL, particularly in response to malarial antigen. Thus, HIV-mediated cytokine dysregulation and impairment of the protective IFN-g response may contribute to the increased susceptibility of HIV-positive pregnant women to malaria. Studies conducted in Malawi [1, 2] and western Kenya [3, 4], countries in which malaria is endemic, have demonstrate