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Species-specific treatment effects of helminth/HIV-1 co-infection: a systematic review and meta-analysis

Published online by Cambridge University Press:  18 May 2011

LAURA R. SANGARÉ ,
BRADELY R. HERRIN ,
GRACE JOHN-STEWART  and
JUDD L. WALSON
LAURA R. SANGARÉ
Affiliation:
University of Washington, Department of Global Health, Box 359909, 325 Ninth Avenue Seattle, WA 98104, USA
BRADELY R. HERRIN
Affiliation:
University of Washington, Department of Global Health, Box 359909, 325 Ninth Avenue Seattle, WA 98104, USA
GRACE JOHN-STEWART
Affiliation:
University of Washington, Department of Global Health, Box 359909, 325 Ninth Avenue Seattle, WA 98104, USA
JUDD L. WALSON*
Affiliation:
University of Washington, Department of Global Health, Box 359909, 325 Ninth Avenue Seattle, WA 98104, USA
*
Corresponding author: Judd L. Walson, MD, MPH Departments of Global Health, Medicine, Pediatrics and Epidemiology, University of Washington, Box 359909, 325 Ninth Avenue Seattle, WA 98104 Tel: (206) 744-3695 Fax: (206) 543-4818 E-mail: walson@u.washington.edu
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Summary

In sub-Saharan Africa, over 22 million people are estimated to be co-infected with both helminths and HIV-1. Several studies have suggested that de-worming individuals with HIV-1 may delay HIV-1 disease progression, and that the benefit of de-worming may vary by individual helminth species. We conducted a systematic review and meta-analysis of the published literature to determine the effect of treatment of individual helminth infections on markers of HIV-1 progression (CD4 count and HIV viral load). There was a trend towards an association between treatment for Schistosoma mansoni and a decrease in HIV viral load (Weighted mean difference (WMD)=−0·10; 95% Confidence interval (CI): −0·24, 0·03), although this association was not seen for Ascaris lumbricoides, hookworm or Trichuris trichiura. Treatment of A. lumbricoides, S. mansoni, hookworm or T. trichiura was not associated with a change in CD4 count. While pooled data from randomized trials suggested clinical benefit of de-worming for individual helminth species, these effects decreased when observational data were included in the pooled analysis. While further trials are needed to confirm the role of anthelmintic treatment in HIV-1 co-infected individuals, providing anthelmintics to individuals with HIV-1 may be a safe, inexpensive and practical intervention to slow progression of HIV-1.

Keywords

HelminthHIV-1co-infectionmeta-analysisKenya
Type
Research Article
Information
Parasitology , Volume 138 , Special Issue 12: Symposia of the British Society for Parasitology Volume 47 , October 2011 , pp. 1546 - 1558
Copyright
Copyright © Cambridge University Press 2011

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