Sex-based differences in clearance of chronic Plasmodium falciparum infection.

Briggs, JessicaORCID logo; Teyssier, Noam; Nankabirwa, Joaniter I; Rek, John; Jagannathan, PrasannaORCID logo; Arinaitwe, Emmanuel; Bousema, TeunORCID logo; Drakeley, ChrisORCID logo; Murray, Margaret; Crawford, Emily; +8 more...Hathaway, Nicholas; Staedke, Sarah GORCID logo; Smith, David; Rosenthal, Phillip J; Kamya, Moses; Dorsey, Grant; Rodriguez-Barraquer, IsabelORCID logo; and Greenhouse, Bryan (2020) Sex-based differences in clearance of chronic Plasmodium falciparum infection. eLife, 9. pp. 1-14. ISSN 2050-084X DOI: 10.7554/eLife.59872
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Multiple studies have reported a male bias in incidence and/or prevalence of malaria infection in males compared to females. To test the hypothesis that sex-based differences in host-parasite interactions affect the epidemiology of malaria, we intensively followed Plasmodium falciparum infections in a cohort in a malaria endemic area of eastern Uganda and estimated both force of infection (FOI) and rate of clearance using amplicon deep-sequencing. We found no evidence of differences in behavioral risk factors, incidence of malaria, or FOI by sex. In contrast, females cleared asymptomatic infections at a faster rate than males (hazard ratio [HR]=1.82, 95% CI 1.20 to 2.75 by clone and HR = 2.07, 95% CI 1.24 to 3.47 by infection event) in multivariate models adjusted for age, timing of infection onset, and parasite density. These findings implicate biological sex-based differences as an important factor in the host response to this globally important pathogen.


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