title: Helminthic infections rates and malaria in HIV-infected pregnant women on anti-retroviral therapy in Rwanda.
abstract: BACKGROUND
  Within sub-Saharan Africa, helminth and malaria infections cause considerable morbidity in HIV-positive pregnant women and their offspring. Helminth infections are also associated with a higher risk of mother-to-child HIV transmission. The aim of this study was to determine the prevalence of, and the protective and risk factors for helminth and malaria infections in pregnant HIV-positive Rwandan women receiving anti-retroviral therapy (ART).
  
  
  RESULTS
  Pregnant females (n = 980) were recruited from health centres in rural and peri-urban locations in the central and eastern provinces of Rwanda. Helminth infection was diagnosed using the Kato Katz method whilst the presence of Plasmodium falciparum was identified from blood smears. The prevalence of helminth infections was 34.3%; of malaria 13.3%, and of co-infections 6.6%. Helminth infections were more common in rural (43.1%) than peri-urban (18.0%; p<0.0005) sites. A CD4 count ≤ 350 cells/mm(3) was associated with a higher risk of helminth infections (odds ratio, 3.39; 95% CIs, 2.16-5.33; p<0.0005) and malaria (3.37 [2.11-5.38]; p<0.0005) whilst helminth infection was a risk factor for malaria infection and vice versa. Education and employment reduced the risk of all types of infection whilst hand washing protected against helminth infection (0.29 [0.19-0.46]; p<0.0005);). The TDF-3TC-NVP (3.47 [2.21-5.45]; p<0.0005), D4T-3TC-NVP (2.47 [1.27-4.80]; p<0.05) and AZT-NVP (2.60 [1.33-5.08]; p<0.05) regimens each yielded higher helminth infection rates than the AZT-3TC-NVP regimen. Anti-retroviral therapy had no effect on the risk of malaria.
  
  
  CONCLUSIONS
  HIV-positive pregnant women would benefit from the scaling up of de-worming programs alongside health education and hygiene interventions. The differential effect of certain ART combinations (as observed here most strongly with AZT-3TC-NVP) possibly protecting against helminth infection warrants further investigation.
authors: Kigali Health Institute Department of Biomedical Laboratory Sciences, Kigali, Rwanda.
authors: Emil
authors: E
authors: Ivan
authors: Nigel J
authors: NJ
authors: Crowther
authors: Eugene
authors: E
authors: Mutimura
authors: Lawrence Obado
authors: LO
authors: Osuwat
authors: Saskia
authors: S
authors: Janssen
authors: Martin P
authors: MP
authors: Grobusch
mesh_terms: D000328:Adult; D060085:Coinfection / Q000453:epidemiology*; D003140:Communicable Disease Control / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006373:Helminthiasis / Q000453:epidemiology*; D006801:Humans; D016778:Malaria, Falciparum / Q000453:epidemiology*; D010274:Parasitology / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult
references: Immunobiology. 2007;212(6):475-90
references: 17544832
references: Lancet. 2011 Jan 1;377(9759):52-62
references: 21176950
references: Acta Trop. 2007 Mar;101(3):200-6
references: 17349963
references: Proc Biol Sci. 1992 Feb 22;247(1319):77-81
references: 1349184
references: Clin Infect Dis. 2010 Feb 15;50(4):531-40
references: 20067426
references: Am J Trop Med Hyg. 2009 Jun;80(6):896-901
references: 19478245
references: Annu Rev Nutr. 2002;22:35-59
references: 12055337
references: Parasitology. 2011 Oct;138(12):1546-58
references: 21729353
references: Lancet Infect Dis. 2010 Jul;10(7):455-63
references: 20610327
references: PLoS Negl Trop Dis. 2009;3(1):e370
references: 19172184
references: Antimicrob Agents Chemother. 2012 Feb;56(2):995-1000
references: 22123685
references: Lancet Infect Dis. 2012 Dec;12(12):925-32
references: 22971323
references: Trop Med Int Health. 2007 Aug;12(8):920-8
references: 17697086
references: PLoS Negl Trop Dis. 2012;6(4):e1547
references: 22545161
references: Int J Parasitol. 2009 Apr;39(5):591-7
references: 19073189
references: Am J Trop Med Hyg. 2011 Mar;84(3):364-9
references: 21363971
references: AIDS. 2005 Nov 4;19(16):1849-55
references: 16227793
references: Braz J Infect Dis. 2008 Apr;12(2):115-22
references: 18641847
references: Trends Immunol. 2001 Jul;22(7):372-7
references: 11429321
references: PLoS Negl Trop Dis. 2010 Mar 30;4(3):e644
references: 20361031
references: Rev Inst Med Trop Sao Paulo. 1972 Nov-Dec;14(6):397-400
references: 4675644
references: PLoS Negl Trop Dis. 2009 Jun 30;3(6):e473
references: 19564904
references: Acta Trop. 2012 Dec;124(3):179-84
references: 22940013
references: PLoS Med. 2012 Jan;9(1):e1001162
references: 22291577
references: Ann Trop Med Parasitol. 2004 Sep;98(6):615-21
references: 15324467
references: Trans R Soc Trop Med Hyg. 2009 Mar;103(3):215-22
references: 18789465
references: AIDS Rev. 2007 Apr-Jun;9(2):88-98
references: 17694676
references: Am J Trop Med Hyg. 1996;55(1 Suppl):17-23
references: 8702032
references: Int J Health Geogr. 2009 Jul 09;8:42
references: 19589144
references: Cochrane Database Syst Rev. 2009 Jul 08;(3):CD006419
references: 19588389
references: Wien Klin Wochenschr. 2007;119(23-24):712-6
references: 18157604
references: Curr Opin HIV AIDS. 2012 May;7(3):245-53
references: 22411451
references: Matern Child Nutr. 2008 Apr;4 Suppl 1:118-236
references: 18289159
references: PLoS Negl Trop Dis. 2012;6(9):e1783
references: 23029572
references: Parasite Immunol. 2006 Nov;28(11):613-23
references: 17042933
references: World Health Organ Tech Rep Ser. 2002;912:i-vi, 1-57, back cover
references: 12592987
references: Trop Doct. 2004 Jan;34(1):27-8
references: 14959970
references: Bull World Health Organ. 1991;69(5):609-21
references: 1835675
references: J Clin Invest. 2008 Apr;118(4):1311-21
references: 18382743
references: Ann Trop Med Parasitol. 2006 Oct;100(7):551-70
references: 16989681
references: J Clin Epidemiol. 1996 Dec;49(12):1373-9
references: 8970487
references: Trop Med Int Health. 2009 Jun;14(6):688-95
references: 19392740