Abstract

Southeast Asian ovalocytosis (SAO), alpha(+)-thalassemia, and low expression of complement receptor 1 (CR1) have been associated with protection against severe Plasmodium falciparum malaria. In a cohort of children 5-14 years of age the effect of alpha(+)-thalassemia, SAO (SLC4A1Delta27), CR1 polymorphisms, and Gerbich negativity (GYPCDeltaex3) on risk of P. falciparum infections and uncomplicated illness were evaluated. The risk of acquiring polymerase chain reaction (PCR)-diagnosed P. falciparum infections was significantly lower for alpha(+)-thalassemia heterozygotes (hazard ratio [HR]: 0.56) and homozygotes (HR: 0.51) than wild-type children. No such differences were seen in light of microscopy diagnosed infections (P = 0.71) or were alpha(+)-thalassemia genotypes associated with a reduced risk of uncomplicated P. falciparum malaria. No significant associations between the risk of P. falciparum infection or illness were observed for any of the other red blood cell polymorphisms (P > 0.2). This suggests that these polymorphisms are not associated with significant protection against P. falciparum blood-stage infection or uncomplicated malaria in school-aged children.