Kigali Health Institute Department of Biomedical Laboratory Sciences, Kigali, Rwanda.
PLoS Negl Trop Dis. 2013 Aug 15;7(8):e2380. doi: 10.1371/journal.pntd.0002380. eCollection 2013.
Within sub-Saharan Africa, helminth and malaria infections cause considerable morbidity in HIV-positive pregnant women and their offspring. Helminth infections are also associated with a higher risk of mother-to-child HIV transmission. The aim of this study was to determine the prevalence of, and the protective and risk factors for helminth and malaria infections in pregnant HIV-positive Rwandan women receiving anti-retroviral therapy (ART).
Pregnant females (n = 980) were recruited from health centres in rural and peri-urban locations in the central and eastern provinces of Rwanda. Helminth infection was diagnosed using the Kato Katz method whilst the presence of Plasmodium falciparum was identified from blood smears. The prevalence of helminth infections was 34.3%; of malaria 13.3%, and of co-infections 6.6%. Helminth infections were more common in rural (43.1%) than peri-urban (18.0%; p<0.0005) sites. A CD4 count ≤ 350 cells/mm(3) was associated with a higher risk of helminth infections (odds ratio, 3.39; 95% CIs, 2.16-5.33; p<0.0005) and malaria (3.37 [2.11-5.38]; p<0.0005) whilst helminth infection was a risk factor for malaria infection and vice versa. Education and employment reduced the risk of all types of infection whilst hand washing protected against helminth infection (0.29 [0.19-0.46]; p<0.0005);). The TDF-3TC-NVP (3.47 [2.21-5.45]; p<0.0005), D4T-3TC-NVP (2.47 [1.27-4.80]; p<0.05) and AZT-NVP (2.60 [1.33-5.08]; p<0.05) regimens each yielded higher helminth infection rates than the AZT-3TC-NVP regimen. Anti-retroviral therapy had no effect on the risk of malaria.
CONCLUSION/SIGNIFICANCE: HIV-positive pregnant women would benefit from the scaling up of de-worming programs alongside health education and hygiene interventions. The differential effect of certain ART combinations (as observed here most strongly with AZT-3TC-NVP) possibly protecting against helminth infection warrants further investigation.
在撒哈拉以南非洲地区，寄生虫和疟疾感染会给 HIV 阳性孕妇及其后代带来严重的发病率。寄生虫感染也与母婴 HIV 传播的风险增加有关。本研究的目的是确定在接受抗逆转录病毒治疗（ART）的卢旺达 HIV 阳性孕妇中，寄生虫和疟疾感染的流行情况，以及其保护和危险因素。
从卢旺达中部和东部省份农村和城郊地区的卫生中心招募了 980 名孕妇。寄生虫感染采用加藤厚涂片法诊断，疟原虫阳性从血涂片鉴定。寄生虫感染的流行率为 34.3%；疟疾为 13.3%，合并感染为 6.6%。农村（43.1%）比城郊（18.0%；p<0.0005）地区寄生虫感染更为常见。CD4 计数≤350 个细胞/mm³与寄生虫感染（比值比，3.39；95%置信区间，2.16-5.33；p<0.0005）和疟疾（3.37 [2.11-5.38]；p<0.0005）的风险增加有关，而寄生虫感染是疟疾感染的危险因素，反之亦然。教育和就业降低了所有类型感染的风险，而洗手可预防寄生虫感染（0.29 [0.19-0.46]；p<0.0005）。TDF-3TC-NVP（3.47 [2.21-5.45]；p<0.0005）、D4T-3TC-NVP（2.47 [1.27-4.80]；p<0.05）和 AZT-NVP（2.60 [1.33-5.08]；p<0.05）方案的寄生虫感染率均高于 AZT-3TC-NVP 方案。抗逆转录病毒治疗对疟疾风险没有影响。
结论/意义：HIV 阳性孕妇将受益于扩大驱虫计划，同时开展健康教育和卫生干预措施。某些 ART 组合（如在这里观察到的 AZT-3TC-NVP 组合）可能对寄生虫感染具有保护作用，这一差异效应值得进一步研究。
