Impact of Anti-Retroviral Treatment and Cotrimoxazole Prophylaxis on Helminth Infections in HIV-Infected Patients in Lambaréné, Gabon

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.背景 人类免疫缺陷病毒（HIV）流行与蠕虫感染的地理分布高度重叠。当前蠕虫感染的治疗选择有限，且该领域的药物研发研究匮乏。现有有限证据表明，抗逆转录病毒疗法（antiretroviral therapy, ART）可降低HIV感染者的蠕虫感染患病率。本研究旨在探讨抗逆转录病毒疗法暴露与复方新诺明预防治疗（cotrimoxazole preventive therapy, CTX-P）是否与蠕虫感染患病率降低相关。 研究方法与主要结果 本横断面研究在加蓬兰巴雷内的一家艾滋病初级诊疗中心开展。未接受过抗逆转录病毒疗法或接受抗逆转录病毒疗法至少3个月的HIV感染成人，在连续3天内分别提交1份血液样本、粪便样本与尿液样本。研究结局为感染肠道蠕虫、埃及血吸虫（Schistosoma haematobium）、罗阿丝虫（Loa loa）或常现曼森线虫（Mansonella perstans）。采用多变量logistic回归分析评估抗逆转录病毒疗法或复方新诺明预防治疗与蠕虫感染之间的关联。本研究共纳入408名受试者。蠕虫感染整体较为普遍（77/252 [30.5%]）。其中丝虫感染最为常见（55/310 [17.7%]），其次为肠道蠕虫感染（35/296 [11.8%]）与埃及血吸虫感染（19/323 [5.9%]）。接受复方新诺明预防治疗的受试者，其罗阿丝虫微丝蚴血症风险显著降低（校正比值比（adjusted odds ratio, aOR）0.47，95%置信区间（confidence interval, CI）0.23~0.97，P = 0.04），在接受抗逆转录病毒疗法的亚组受试者中亦观察到该效应（aOR 0.36，95% CI 0.13~0.96，P = 0.04）。未发现抗逆转录病毒疗法暴露对蠕虫感染患病率存在影响。 结论与意义 复方新诺明预防治疗的使用与罗阿丝虫感染风险降低相关，提示抗叶酸类药物具有抗蠕虫作用。未发现抗逆转录病毒疗法的使用与蠕虫感染之间存在关联。