Albendazole treatment of HIV-1 and helminth co-infection: a randomized, double-blind, placebo-controlled trial.
OBJECTIVE
Several co-infections have been shown to impact the progression of HIV-1 infection. We sought to determine if treatment of helminth co-infection in HIV-1-infected adults impacted markers of HIV-1 disease progression.


METHODS
To date, there have been no randomized trials to examine the effects of soil-transmitted helminth eradication on markers of HIV-1 progression.


METHODS
A randomized, double-blind, placebo-controlled trial of albendazole (400 mg daily for 3 days) in antiretroviral-naive HIV-1-infected adults (CD4 cell count >200 cells/microl) with soil-transmitted helminth infection was conducted at 10 sites in Kenya (ClinicalTrials.gov NCT00130910). CD4 and plasma HIV-1 RNA levels at 12 weeks following randomization were compared in the trial arms using linear regression, adjusting for baseline values.


RESULTS
Of 1551 HIV-1-infected individuals screened for helminth infection, 299 were helminth infected. Two hundred and thirty-four adults were enrolled and underwent randomization and 208 individuals were included in intent-to-treat analyses. Mean CD4 cell count was 557 cells/microl and mean plasma viral load was 4.75 log10 copies/ml at enrollment. Albendazole therapy resulted in significantly higher CD4 cell counts among individuals with Ascaris lumbricoides infection after 12 weeks of follow-up (+109 cells/microl; 95% confidence interval +38.9 to +179.0, P = 0.003) and a trend for 0.54 log10 lower HIV-1 RNA levels (P = 0.09). These effects were not seen with treatment of other species of soil-transmitted helminths.


CONCLUSIONS
Treatment of A. lumbricoides with albendazole in HIV-1-coinfected adults resulted in significantly increased CD4 cell counts during 3-month follow-up. Given the high prevalence of A. lumbricoides infection worldwide, deworming may be an important potential strategy to delay HIV-1 progression.
Walson
Judd L
JL
Centre for Clinical Research, Kenya Medical Research Institute, University of Nairobi, Nairobi, Kenya. walson@u.washington.edu
Otieno
Phelgona A
PA
Mbuchi
Margaret
M
Richardson
Barbra A
BA
Lohman-Payne
Barbara
B
Macharia
Steve Wanyee
SW
Overbaugh
Julie
J
Berkley
James
J
Sanders
Eduard J
EJ
Chung
Michael H
MH
John-Stewart
Grace C
GC
D000328:Adult; D015766:Albendazole / Q000627:therapeutic use*; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use*; D001196:Ascariasis / Q000188:drug therapy / Q000821:virology; D017164:Ascaris lumbricoides; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000469:parasitology*; D015497:HIV-1 / Q000235:genetics; D006373:Helminthiasis / Q000188:drug therapy* / Q000821:virology; D006376:Helminths; D006801:Humans; D016014:Linear Models; D008297:Male; D010919:Placebos; D012367:RNA, Viral / Q000097:blood; D013045:Species Specificity; D019562:Viral Load
D000871:Anthelmintics; D010919:Placebos; D012367:RNA, Viral; D015766:Albendazole