Janssen Saskia, Hermans Sabine, Knap Martijn, Moekotte Alma, Rossatanga Elie G, Adegnika Akim A, Bélard Sabine, Hänscheid Thomas, Grobusch Martin P
Center for Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Traitement Ambulatoire (CTA), Lambaréné, Gabon; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Desmond Tutu HIV Centre, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
PLoS Negl Trop Dis. 2015 May 20;9(5):e0003769. doi: 10.1371/journal.pntd.0003769. eCollection 2015 May.
Foci 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.
This 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/SIGNIFICANCE: CTX-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.
HIV 疫情和蠕虫感染的病灶在很大程度上在地理上重叠。蠕虫感染的治疗选择有限，并且该领域的药物研发研究匮乏。有限的证据表明抗逆转录病毒疗法（ART）可降低 HIV 感染者中蠕虫感染的患病率。我们调查了 ART 暴露和复方新诺明预防性治疗（CTX-P）是否与蠕虫感染患病率降低相关。
这项横断面研究在加蓬兰巴雷内的一家初级 HIV 诊所进行。未接受过 ART 治疗或接受 ART 治疗至少 3 个月的 HIV 感染成年人连续 3 天提交一份血液样本以及粪便和尿液样本。结局指标是肠道蠕虫、埃及血吸虫、罗阿丝虫或常现曼森线虫引起的蠕虫感染。采用多变量逻辑回归评估 ART 或 CTX-P 与蠕虫感染之间的关联。总共招募了 408 名患者。蠕虫感染很常见（77/252 [30.5%]）。丝虫感染最为普遍（55/310 [17.7%]），其次是肠道蠕虫感染（35/296 [11.8%]）和埃及血吸虫感染（19/323 [5.9%]）。接受 CTX-P 治疗的患者出现罗阿丝虫微丝蚴血症的风险降低（调整后的优势比（aOR）为 0.47，95%置信区间为 0.23 - 0.97，P = 0.04），在接受 ART 治疗的患者亚组中也是如此（aOR 为 0.36，95%置信区间为 0.13 - 0.96，P = 0.04）。ART 暴露对蠕虫感染患病率没有影响。
结论/意义：使用 CTX-P 与罗阿丝虫感染风险降低相关，提示抗叶酸药物具有驱虫作用。未确立 ART 使用与蠕虫感染之间的关系。
