Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 212, Issue 4, Pages 626-634Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiv098
Keywords
Burkina Faso; Fulani; hemoglobin C; hemoglobin S; Plasmodium falciparum; infection
Categories
Funding
- MalariaGEN Project
- Wellcome Trust [WT077383/Z/05/Z, 090532/Z/09/Z, 098051, 091924]
- Bill & Melinda Gates Foundation through the Foundation of the National Institutes of Health as part of the Grand Challenges in Global Health Initiative [566]
- Medical Research Council [G0600718]
- Istituto Pasteur-Fondazione Cenci Bolognetti (Borse Italia)
- Evimalar (European Community) [242095]
- Italian Malaria Network
- Compagnia di San Paolo, Turin, Italy
- Fundacao Para a Ciencia e Tecnologia [Pest-OE/MAT/UI0006/2011]
- MRC [MR/M006212/1, G0600718] Funding Source: UKRI
- Medical Research Council [G0600718, MR/M006212/1] Funding Source: researchfish
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Although hemoglobin S (HbS) and hemoglobin C (HbC) are well known to protect against severe Plasmodium falciparum malaria, conclusive evidence on their role against infection has not yet been obtained. Here we show, in 2 populations from Burkina Faso (2007-2008), that HbS is associated with a 70% reduction of harboring P. falciparum parasitemia at the heterozygous state (odds ratio [OR] for AS vs AA, 0.27; 95% confidence interval [CI], .11-.66; P = .004). There is no evidence of protection for HbC in the heterozygous state (OR for AC vs AA, 1.49; 95% CI, .69-3.21; P = .31), whereas protection even higher than that observed with AS is observed in the homozygous and double heterozygous states (OR for CC + SC vs AA, 0.04; 95% CI, .01-.29; P = .002). The abnormal display of parasite-adhesive molecules on the surface of HbS and HbC infected erythrocytes, disrupting the pathogenic process of sequestration, might displace the parasite from the deep to the peripheral circulation, promoting its elimination at the spleen level.
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