Helminth infection is not associated with faster progression of HIV disease in coinfected adults in Uganda.
BACKGROUND
We studied a cohort of human immunodeficiency virus (HIV)-infected adults in Uganda who were not receiving antiretroviral therapy, to explore the impact of helminths on HIV progression in areas where antiretrovirals are not available.


METHODS
A total of 663 patients were screened for helminths, treated presumptively with albendazole and selectively with praziquantel, and monitored for 6 months. Blood samples were analyzed for CD4+ cell count and HIV-1 RNA.


RESULTS
Schistosoma mansoni, hookworm, Strongyloides stercoralis, and Mansonella perstans were the most prevalent helminths. Helminth infection was not associated with higher viral load, lower CD4+ cell count, or faster decrease in CD4+ cell count preceding antihelminthic therapy. The effect of coinfection on HIV disease progression varied with species. CD4+ cell counts were highest in subjects with hookworm and Mansonella perstans infection. For most helminths, effective treatment was associated with greater decrease in CD4+ cell count than in those in whom infection was still present at follow-up. A highly significant decrease in viral load at 6 months was seen in patients with persistent Mansonella perstans infection at follow-up. Mortality was lower in subjects with hookworm infection at enrollment.


CONCLUSIONS
Helminth infection was not associated with more-advanced HIV disease or faster disease progression. Antihelminthic therapy may not be beneficial in slowing HIV progression in coinfected adults.
Brown
Michael
M
Uganda Virus Research Institute, Entebbe, United Kingdom. michael.brown@lshtm.ac.uk
Kizza
Moses
M
Watera
Christine
C
Quigley
Maria A
MA
Rowland
Samantha
S
Hughes
Peter
P
Whitworth
James A G
JA
Elliott
Alison M
AM
D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000723:Ancylostomatoidea / Q000302:isolation & purification; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000503:physiopathology*; D006725:Hookworm Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008366:Mansonella / Q000302:isolation & purification; D008368:Mansonelliasis / Q000150:complications* / Q000188:drug therapy; D009026:Mortality; D011223:Praziquantel / Q000627:therapeutic use; D012550:Schistosoma mansoni / Q000302:isolation & purification; D012555:Schistosomiasis mansoni / Q000150:complications* / Q000188:drug therapy; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000150:complications* / Q000188:drug therapy; D014454:Uganda; D019562:Viral Load
D000871:Anthelmintics; D011223:Praziquantel; D015766:Albendazole