Schistosomiasis and HIV in rural Zimbabwe: efficacy of treatment of schistosomiasis in individuals with HIV coinfection.
BACKGROUND
There is evidence from experimental models that the praziquantel-induced clearance of schistosomiasis is dependent on the host's immune response. Consequently, human immunodeficiency virus (HIV)-related immunodeficiency may impair the effect of praziquantel treatment.


METHODS
In a prospective cohort study, schistosome-infected subjects who were or were not coinfected with HIV were treated with praziquantel and followed up 3, 6, and 12 months after treatment. Quantitative measures of intensity of schistosomiasis (egg counts and levels of circulating anodic antigen in serum) and immunodeficiency (CD4+ cell counts and viral loads) were collected.


RESULTS
Cure rates based on egg counts 3 months after treatment were satisfactory and were similar for HIV-positive individuals (cure rate, 86%) and HIV-negative individuals (cure rate, 85%); the magnitude of decrease in egg count was equal. Cure rates based on circulating anodic antigen levels were much lower than cure rates based on egg counts, with HIV-positive individuals experiencing significantly less clearance of schistosomiasis (cure rate, 31%) than HIV-negative individuals (cure rate, 52%), whereas the magnitude of decrease in circulating anodic antigen was also lower among HIV-positive individuals (P < .01).


CONCLUSIONS
The effect of praziquantel may be limited to affecting the fecundity of adult schistosomes in the immunocompromised host, thus reducing egg excretion while leaving schistosomes metabolically active, as shown by the fact that levels of antigen production are maintained. Special guidelines for treatment of schistosomiasis in HIV-coinfected individuals may need to be developed.
Kallestrup
Per
P
Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. kallestrup@dadlnet.dk
Zinyama
Rutendo
R
Gomo
Exnevia
E
Butterworth
Anthony E
AE
van Dam
Govert J
GJ
Gerstoft
Jan
J
Erikstrup
Christian
C
Ullum
Henrik
H
D000328:Adult; D000871:Anthelmintics / Q000627:therapeutic use*; D000947:Antigens, Helminth / Q000097:blood; D018791:CD4 Lymphocyte Count; D005243:Feces / Q000469:parasitology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D010270:Parasite Egg Count; D011223:Praziquantel / Q000627:therapeutic use*; D012552:Schistosomiasis / Q000150:complications* / Q000188:drug therapy*; D019562:Viral Load; D015030:Zimbabwe
D000871:Anthelmintics; D000947:Antigens, Helminth; D011223:Praziquantel