HIVMALARIA · HIV-malaria co-infections: a significant source of antimalarial drug resistance?

The rise and spread of drug resistant malaria parasites is one of the major challenges for malaria control and may soon proof to be one of the biggest obstacles to malaria eradication. Due to extensive geographical overlap of HIV and malaria, the two most serious health problems in the world, co-infections are common in nature. These co-infections may increase the emergence and spread of malaria drug resistance, as a result of intervention strategies and weaker immune systems. However, evidence for this is lacking and discussion is speculative of nature. Using an evolutionary framework, I aim to unravel (1) the link between HIV infection and frequency of malaria drug resistance and (2) the selective forces that drive this resistance to higher levels in HIV co-infected individuals.I will start with a meta-analysis of published studies to determine whether a correlation between prevalence of resistance and prevalence of HIV infection can be seen. In addition, using clinical samples of HIV-positive and HIV-negative pregnant women from five different countries in Sub-Saharan Africa who are currently enrolled in a clinical trial with the aim to test the efficacy of Intermittent Preventative Therapy, I will (i) assess the frequency of resistance markers by direct sequencing, (ii) study the multiplicity of malaria infection using genetic barcoding and (iii) determine the densities of the transmission stages using stage-specific qPCR. I will evaluate these metrics at the start of the intervention, at time of delivery and, from a subset of women in an ancillary study, during the course of pregnancy.This fellowship merges my expertise in evolutionary biology of infectious diseases with the host’s expertise in clinical malaria in pregnant women. This project has the potential to have a big impact on public health policy, increase our understanding of malaria parasite dynamics in as-of-yet much understudied pregnant women, and contribute critically to malaria eradication.