title: Effects of albendazole on the clinical outcome and immunological responses in helminth co-infected tuberculosis patients: a double blind randomised clinical trial.
abstract: Despite several review papers and experimental studies concerning the impact of chronic helminth infection on tuberculosis in recent years, there is a scarcity of data from clinical field studies in highly endemic areas for these diseases. We believe this is the first randomised clinical trial investigating the impact of albendazole treatment on the clinical and immunological outcomes of helminth co-infected tuberculosis patients. A randomised, double-blind, placebo-controlled trial of albendazole (400mg per day for 3 days) in helminth-positive tuberculosis patients was conducted in Gondar, Ethiopia. The primary outcome was clinical improvement (ΔTB score) after 2 months. Among secondary outcomes were changes in the levels of eosinophils, CD4+ T cells, regulatory T cells, IFN-γ, IL-5 and IL-10 after 3 months. A total of 140 helminth co-infected tuberculosis patients were included with an HIV co-infection rate of 22.8%. There was no significant effect on the primary outcome (ΔTB score: 5.6±2.9 for albendazole versus 5.9±2.5 for placebo, P=0.59). The albendazole-treated group showed a decline in eosinophil cells (P=0.001) and IL-10 (P=0.017) after 3 months. In an exploratory analysis after 12 weeks, the albendazole treated group showed a trend towards weight gain compared with the placebo group (11.2±8.5 kg versus 8.2±8.7 kg, P=0.08)). The reductions in eosinophil counts and IL-10 show that asymptomatic helminth infection significantly affects host immunity during tuberculosis and can be effectively reversed by albendazole treatment. The clinical effects of helminth infection on chronic infectious diseases such as tuberculosis merit further characterisation.
authors.affiliation: Department of Immunology and Molecular Biology, University of Gondar, Gondar, Ethiopia; Department of Medical Microbiology, Linköping University, Sweden. Electronic address: ebbaabate@yahoo.com.
authors.forename: E
authors.initials: E
authors.lastname: Abate
authors.affiliation: University of Southern Denmark, Institute of Molecular Medicine, Department of Cancer and Inflammation, Odense, Denmark.
authors.forename: D
authors.initials: D
authors.lastname: Elias
authors.affiliation: Department of Radiology, University of Gondar, Gondar, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Getachew
authors.affiliation: Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: S
authors.initials: S
authors.lastname: Alemu
authors.affiliation: Department of Internal Medicine, University of Gondar, Gondar, Ethiopia.
authors.forename: E
authors.initials: E
authors.lastname: Diro
authors.affiliation: Department of Infectious Diseases, Karolinska Hospital, Stockholm, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Britton
authors.affiliation: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
authors.forename: A
authors.initials: A
authors.lastname: Aseffa
authors.affiliation: Department of Medical Microbiology, Linköping University, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Stendahl
authors.affiliation: Department of Medical Microbiology, Linköping University, Sweden; Department of Clinical Microbiology and Infectious Diseases, Kalmar County Hospital, Kalmar, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Schön
mesh_terms: D000293:Adolescent; D000328:Adult; D015766:Albendazole / Q000627:therapeutic use*; D000871:Anthelmintics / Q000627:therapeutic use*; D001835:Body Weight; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D004804:Eosinophils / Q000276:immunology; D005002:Ethiopia; D005260:Female; D006373:Helminthiasis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos / Q000008:administration & dosage; D050378:T-Lymphocytes, Regulatory / Q000276:immunology; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications*; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D016207:Cytokines; D010919:Placebos; D015766:Albendazole
keywords: Albendazole; Deworming; Ethiopia; HIV; Helminth; Tuberculosis