Schistosomiasis and HIV-1 Viral Load in HIV-infected Outpatients with Immunological Failure in Tanzania: a Case-control Study

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2019 Mar 15

PMID 30866830

Citations 2

Authors

Peter Masikini

Soledad Colombe

Amon Marti

Bernard Desderius

Claudia J de Dood

Paul L A M Corstjens

Govert J van Dam

Mwanaisha Seugendo

Samuel Kalluvya

Jennifer A Downs

Affiliations

Soon will be listed here.

Abstract

Background: 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. 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.

Methods: We 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/mm 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.

Results: A 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.

Conclusions: The 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.

Citing Articles

Prevalence of human schistosomiasis in various regions of Tanzania Mainland and Zanzibar: A systematic review and meta-analysis of studies conducted for the past ten years (2013-2023).

Mbugi N, Laizer H, Chacha M, Mbega E PLoS Negl Trop Dis. 2024; 18(9):e0012462.

PMID: 39250468 PMC: 11412511. DOI: 10.1371/journal.pntd.0012462.

Effects of schistosomes on host anti-viral immune response and the acquisition, virulence, and prevention of viral infections: A systematic review.

Bullington B, Klemperer K, Mages K, Chalem A, Mazigo H, Changalucha J PLoS Pathog. 2021; 17(5):e1009555.

PMID: 34015063 PMC: 8172021. DOI: 10.1371/journal.ppat.1009555.

References

Lawn S, Karanja D, Mwinzia P, Andove J, Colley D, Folks T . The effect of treatment of schistosomiasis on blood plasma HIV-1 RNA concentration in coinfected individuals. AIDS. 2000; 14(16):2437-43. DOI: 10.1097/00002030-200011100-00004. View

Phillips A, Staszewski S, Weber R, Kirk O, Francioli P, Miller V . HIV viral load response to antiretroviral therapy according to the baseline CD4 cell count and viral load. JAMA. 2001; 286(20):2560-7. DOI: 10.1001/jama.286.20.2560. View

Elliott A, Mawa P, Joseph S, Namujju P, Kizza M, Nakiyingi J . Associations between helminth infection and CD4+ T cell count, viral load and cytokine responses in HIV-1-infected Ugandan adults. Trans R Soc Trop Med Hyg. 2003; 97(1):103-8. DOI: 10.1016/s0035-9203(03)90040-x. View

Brown M, Kizza M, Watera C, Quigley M, Rowland S, Hughes P . Helminth infection is not associated with faster progression of HIV disease in coinfected adults in Uganda. J Infect Dis. 2004; 190(10):1869-79. DOI: 10.1086/425042. View

Brown M, Mawa P, Joseph S, Bukusuba J, Watera C, Whitworth J . Treatment of Schistosoma mansoni infection increases helminth-specific type 2 cytokine responses and HIV-1 loads in coinfected Ugandan adults. J Infect Dis. 2005; 191(10):1648-57. DOI: 10.1086/429668. View

Kallestrup P, Zinyama R, Gomo E, Butterworth A, Mudenge B, van Dam G . Schistosomiasis and HIV-1 infection in rural Zimbabwe: effect of treatment of schistosomiasis on CD4 cell count and plasma HIV-1 RNA load. J Infect Dis. 2005; 192(11):1956-61. DOI: 10.1086/497696. View

Kjetland E, Ndhlovu P, Gomo E, Mduluza T, Midzi N, Gwanzura L . Association between genital schistosomiasis and HIV in rural Zimbabwean women. AIDS. 2006; 20(4):593-600. DOI: 10.1097/01.aids.0000210614.45212.0a. View

van Griensven J, De Naeyer L, Mushi T, Ubarijoro S, Gashumba D, Gazille C . High prevalence of lipoatrophy among patients on stavudine-containing first-line antiretroviral therapy regimens in Rwanda. Trans R Soc Trop Med Hyg. 2007; 101(8):793-8. DOI: 10.1016/j.trstmh.2007.02.020. View

Walson J, John-Stewart G . Treatment of helminth co-infection in individuals with HIV-1: A systematic review of the literature. PLoS Negl Trop Dis. 2007; 1(3):e102. PMC: 2154389. DOI: 10.1371/journal.pntd.0000102. View

10.

Ndembi N, Lyagoba F, Nanteza B, Kushemererwa G, Serwanga J, Katongole-Mbidde E . Transmitted antiretroviral drug resistance surveillance among newly HIV type 1-diagnosed women attending an antenatal clinic in Entebbe, Uganda. AIDS Res Hum Retroviruses. 2008; 24(6):889-95. DOI: 10.1089/aid.2007.0317. View

11.

Ngowi B, Mfinanga S, Bruun J, Morkve O . Immunohaematological reference values in human immunodeficiency virus-negative adolescent and adults in rural northern Tanzania. BMC Infect Dis. 2009; 9:1. PMC: 2630915. DOI: 10.1186/1471-2334-9-1. View

12.

Singh K, Spector S . Host genetic determinants of human immunodeficiency virus infection and disease progression in children. Pediatr Res. 2009; 65(5 Pt 2):55R-63R. PMC: 2802664. DOI: 10.1203/PDR.0b013e31819dca03. View

13.

Kiwanuka N, Robb M, Laeyendecker O, Kigozi G, Wabwire-Mangen F, Makumbi F . HIV-1 viral subtype differences in the rate of CD4+ T-cell decline among HIV seroincident antiretroviral naive persons in Rakai district, Uganda. J Acquir Immune Defic Syndr. 2009; 54(2):180-4. PMC: 2877752. DOI: 10.1097/QAI.0b013e3181c98fc0. View

14.

Easterbrook P, Smith M, Mullen J, OShea S, Chrystie I, de Ruiter A . Impact of HIV-1 viral subtype on disease progression and response to antiretroviral therapy. J Int AIDS Soc. 2010; 13:4. PMC: 2827379. DOI: 10.1186/1758-2652-13-4. View

15.

Chalamilla G, Hawkins C, Okuma J, Spiegelman D, Aveika A, Christian B . Mortality and treatment failure among HIV-infected adults in Dar Es Salaam, Tanzania. J Int Assoc Physicians AIDS Care (Chic). 2011; 11(5):296-304. DOI: 10.1177/1545109711406733. View

16.

Sangare L, Herrin B, Herrin B, John-Stewart G, Walson J . Species-specific treatment effects of helminth/HIV-1 co-infection: a systematic review and meta-analysis. Parasitology. 2011; 138(12):1546-58. PMC: 3387276. DOI: 10.1017/S0031182011000357. View

17.

Kasang C, Kalluvya S, Majinge C, Stich A, Bodem J, Kongola G . HIV drug resistance (HIVDR) in antiretroviral therapy-naïve patients in Tanzania not eligible for WHO threshold HIVDR survey is dramatically high. PLoS One. 2011; 6(8):e23091. PMC: 3158766. DOI: 10.1371/journal.pone.0023091. View

18.

Menezes C, Maskew M, Sanne I, Crowther N, Raal F . A longitudinal study of stavudine-associated toxicities in a large cohort of South African HIV infected subjects. BMC Infect Dis. 2011; 11:244. PMC: 3189398. DOI: 10.1186/1471-2334-11-244. View

19.

Walson J, Singa B, Sangare L, Naulikha J, Piper B, Richardson B . Empiric deworming to delay HIV disease progression in adults with HIV who are ineligible for initiation of antiretroviral treatment (the HEAT study): a multi-site, randomised trial. Lancet Infect Dis. 2012; 12(12):925-32. DOI: 10.1016/S1473-3099(12)70207-4. View

20.

Downs J, van Dam G, Changalucha J, Corstjens P, Peck R, de Dood C . Association of Schistosomiasis and HIV infection in Tanzania. Am J Trop Med Hyg. 2012; 87(5):868-73. PMC: 3516262. DOI: 10.4269/ajtmh.2012.12-0395. View