Hemoglobin C Trait Provides Protection From Clinical Falciparum Malaria in Malian Children.
Hemoglobin C trait, like hemoglobin S trait, protects against severe malaria in children, but it is unclear whether hemoglobin C trait also protects against uncomplicated malaria. We hypothesized that Malian children with hemoglobin C trait would have a lower risk of clinical malaria than children with hemoglobin AA.Three hundred children aged 0-6 years were enrolled in a cohort study of malaria incidence in Bandiagara, Mali, with continuous passive and monthly active follow-up from June 2009 to June 2010.Compared to hemoglobin AA children (n = 242), hemoglobin AC children (n = 39) had a longer time to first clinical malaria episode (hazard ratio [HR], 0.19; P = .001; 364 median malaria-free days vs 181 days), fewer episodes of clinical malaria, and a lower cumulative parasite burden. Similarly, hemoglobin AS children (n = 14) had a longer time to first clinical malaria episode than hemoglobin AA children (HR, 0.15; P = .015; 364 median malaria-free days vs 181 days), but experienced the most asymptomatic malaria infections of any group.Both hemoglobin C and S traits exerted a protective effect against clinical malaria episodes, but appeared to do so by mechanisms that differentially affect the response to infecting malaria parasites.
Travassos, MA; Coulibaly, D; Laurens, MB; Dembélé, A; Tolo, Y; Koné, AK; Traoré, K; Niangaly, A; Guindo, A; Wu, Y; Berry, AA; Jacob, CG; Takala-Harrison, S; Adams, M; Shrestha, B; Mu, AZ; Kouriba, B; Lyke, KE; Diallo, DA; Doumbo, OK; Plowe, CV; Thera, MA
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