Abstract
BackgroundSchistosoma sp. infection has been shown to interact with HIV-1 by modifying susceptibility to the virus and impacting AIDS outcome, but very little is known about the potential impact of Schistosoma sp. infection on the efficiency of antiretroviral treatment (ART) in HIV-1 infected individuals. One study suggested increased immunological failure in patients infected with schistosomes compared to those uninfected. To our knowledge, no report exists on the virological response to ART in schistosome-infected individuals. In addition, viral load in HIV-1 infected individuals changes over the course of the HIV infection. This study assessed the impact of HIV-1/Schistosoma sp. co-infections on viral load in people with immunological failure on ART, taking into account the duration of HIV-1 infection.MethodsWe enrolled HIV-1 infected Tanzanian adults over 18 years of age who had used first line ART for more than 6 months and were identified to have immunological failure by the WHO criteria (50% drop from peak CD4 count, or CD4 count equal to or below baseline after 6 months of ART, or CD4 count below 100cells/mm3 after 1 year of ART). Patients were also tested for schistosome infection by microscopy for ova in urine and stool and by circulating anodic antigen (CAA) levels in serum. The duration of HIV-1 infection was calculated using baseline CD4+ T-cell (CD4) counts determined at enrollment. Univariable and multivariable analyses were conducted to compare viral loads in schistosome infected and uninfected patients.ResultsA total of 188 patients were enrolled. After univariable analysis, female sex, lower peak CD4 counts, lower current CD4 counts, anemia, and shorter time infected with HIV-1 were all significantly associated with higher viral load. Schistosome infection was not associated with viral load even after adjusting for sex, current CD4 counts and duration of HIV-1 infection.ConclusionsThe current study of HIV-infected patients with immunological failure on ART suggests that once ART is introduced, ART is the dominant driver of viral load and schistosome infection may no longer have an impact.
Highlights
Schistosoma sp. infection has been shown to interact with HIV-1 by modifying susceptibility to the virus and impacting AIDS outcome, but very little is known about the potential impact of Schistosoma sp. infection on the efficiency of antiretroviral treatment (ART) in HIV-1 infected individuals
We found no association between schistosome infection and viral loads among patients with immunological failure, including after adjustment for time infected with HIV-1
This suggests that observed effects of schistosome infection on HIV-1 viral load occur in the absence of ART and that, once ART commences, effective ART is the dominant driver of viral load
Summary
Schistosoma sp. infection has been shown to interact with HIV-1 by modifying susceptibility to the virus and impacting AIDS outcome, but very little is known about the potential impact of Schistosoma sp. infection on the efficiency of antiretroviral treatment (ART) in HIV-1 infected individuals. Infection has been shown to interact with HIV-1 by modifying susceptibility to the virus and impacting AIDS outcome, but very little is known about the potential impact of Schistosoma sp. Viral load in HIV-1 infected individuals changes over the course of the HIV infection. Co-infections on viral load in people with immunological failure on ART, taking into account the duration of HIV-1 infection. Infection has been shown to increase susceptibility to HIV and to impact HIV/AIDS outcomes [3,4,5,6,7,8]. One study from Tanzania showed schistosome infection to be significantly associated with immunological failure and poorer CD4+ T-cells (CD4) count gain with ART [10]. That study did not investigate whether the immunological failure was associated with concomitant increase of viral load (virological failure). Results from human studies of schistosome infection and HIV-1 RNA viral loads are variable, with some showing lower and some showing higher viral replication during schistosome co-infection [3, 11,12,13,14,15,16,17,18]
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