Prevalence and correlates of helminth co-infection in Kenyan HIV-1 infected adults

Judd L Walson, Barclay T Stewart, Laura Sangaré, Loice W Mbogo, Phelgona A Otieno, Benjamin K S Piper, Barbra A Richardson, Grace John-Stewart, Judd L Walson, Barclay T Stewart, Laura Sangaré, Loice W Mbogo, Phelgona A Otieno, Benjamin K S Piper, Barbra A Richardson, Grace John-Stewart

Abstract

Background: Deworming HIV-1 infected individuals may delay HIV-1 disease progression. It is important to determine the prevalence and correlates of HIV-1/helminth co-infection in helminth-endemic areas.

Methods: HIV-1 infected individuals (CD4>250 cells/ul) were screened for helminth infection at ten sites in Kenya. Prevalence and correlates of helminth infection were determined. A subset of individuals with soil-transmitted helminth infection was re-evaluated 12 weeks following albendazole therapy.

Results: Of 1,541 HIV-1 seropositive individuals screened, 298 (19.3%) had detectable helminth infections. Among individuals with helminth infection, hookworm species were the most prevalent (56.3%), followed by Ascaris lumbricoides (17.1%), Trichuris trichiura (8.7%), Schistosoma mansoni (7.1%), and Strongyloides stercoralis (1.3%). Infection with multiple species occurred in 9.4% of infections. After CD4 count was controlled for, rural residence (RR 1.40, 95% CI: 1.08-1.81), having no education (RR 1.57, 95% CI: 1.07-2.30), and higher CD4 count (RR 1.36, 95% CI: 1.07-1.73) remained independently associated with risk of helminth infection. Twelve weeks following treatment with albendazole, 32% of helminth-infected individuals had detectable helminths on examination. Residence, education, and CD4 count were not associated with persistent helminth infection.

Conclusions: Among HIV-1 seropositive adults with CD4 counts above 250 cells/mm(3) in Kenya, traditional risk factors for helminth infection, including rural residence and lack of education, were associated with co-infection, while lower CD4 counts were not.

Trial registration: ClinicalTrials.gov NCT00130910.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1. CONSORT flowchart of study screening…
Figure 1. CONSORT flowchart of study screening and enrollment.
Figure 2. Geographic distribution and prevalence of…
Figure 2. Geographic distribution and prevalence of helminth infection by species and screening region in Kenya.
The black dots represent the relative locations of the ten sites where screening occurred. The number of individuals screened (and percent of total) in each region is listed. The prevalence of helminth infection in each region is listed below in bold. The number of infections for each species and column percents are shown for each region.
Figure 3. Median CD4 count and plasma…
Figure 3. Median CD4 count and plasma HIV RNA level by helminth species.
aNo HIV RNA data were available for S. stercoralis or S. mansoni. The study aimed to recruit pre-HAART individuals with CD4 counts greater than 250 cells. Participants were allowed to give CD4 count measurements from their prior HIV Care and Treatment Clinic visit if it fell within three months of the screening date. However, when these CD4 counts were confirmed, many people had lower CD4 counts than recorded by history. Eighty-nine participants had CD4 counts between 0–199 cells/µL3 and 256 participants had CD4 counts between 200–349 cells/µL3.
Figure 4. Species-specific helminth infection twelve weeks…
Figure 4. Species-specific helminth infection twelve weeks after albendazole or placebo treatment.
1Total number of individuals with follow-up stool available, stratified by species of initial infection and treatment arm. ALB, albendazole; PLC, placebo.

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