Abstract
BackgroundFoci of the HIV epidemic and helminthic infections largely overlap geographically. Treatment options for helminth infections are limited, and there is a paucity of drug-development research in this area. Limited evidence suggests that antiretroviral therapy (ART) reduces prevalence of helminth infections in HIV-infected individuals. We investigated whether ART exposure and cotrimoxazole preventive therapy (CTX-P) is associated with a reduced prevalence of helminth infections.Methodology and Principal FindingsThis cross-sectional study was conducted at a primary HIV-clinic in Lambaréné, Gabon. HIV-infected adults who were ART-naïve or exposed to ART for at least 3 months submitted one blood sample and stool and urine samples on 3 consecutive days. Outcome was helminth infection with intestinal helminths, Schistosoma haematobium, Loa loa or Mansonella perstans. Multivariable logistic regression was used to assess associations between ART or CTX-P and helminth infection. In total, 408 patients were enrolled. Helminth infection was common (77/252 [30.5%]). Filarial infections were most prevalent (55/310 [17.7%]), followed by infection with intestinal helminths (35/296 [11.8%]) and S. haematobium (19/323 [5.9%]). Patients on CTX-P had a reduced risk of Loa loa microfilaremia (adjusted odds ratio (aOR) 0.47, 95% CI 0.23-0.97, P = 0.04), also in the subgroup of patients on ART (aOR 0.36, 95% CI 0.13-0.96, P = 0.04). There was no effect of ART exposure on helminth infection prevalence.Conclusions/SignificanceCTX-P use was associated with a decreased risk of Loa loa infection, suggesting an anthelminthic effect of antifolate drugs. No relation between ART use and helminth infections was established.
Highlights
More than 2 billion people are estimated to be infected with soil-transmitted helminths, and the geographical distribution of these infections overlaps considerably with regions of high HIV sero-prevalence [1,2]
The geographical distribution of helminth infections, which are highly prevalent in many areas, overlaps considerably with regions of high HIV sero-prevalence
We aimed to investigate whether antiretroviral therapy (ART) or cotrimoxazole preventive treatment (CTX-P) reduces prevalence of helminth infection in HIV-infected individuals attending a primary HIV clinic in a semi-rural area in Gabon
Summary
More than 2 billion people are estimated to be infected with soil-transmitted helminths, and the geographical distribution of these infections overlaps considerably with regions of high HIV sero-prevalence [1,2]. Treatment of intestinal helminth infections and schistosomiasis is relatively simple and cheap, current options are limited to a few drugs, and emergence of resistance is anticipated [6,7]. DEC or ivermectin treatment may cause serious adverse reactions due to microfilarial disintegration triggering a cytokine release [8]. This underscores the need for new drugs for the treatment of helminth infections. Limited evidence suggests that antiretroviral therapy (ART) reduces prevalence of helminth infections in HIV-infected individuals. We investigated whether ART exposure and cotrimoxazole preventive therapy (CTX-P) is associated with a reduced prevalence of helminth infections
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