Department of Medicine, Bugando Medical Centre, Mwanza, Tanzania.
Center for Global Health, Department of Medicine, Weill Cornell Medicine, New York, USA.
BMC Infect Dis. 2019 Mar 12;19(1):249. doi: 10.1186/s12879-019-3876-8.
Schistosoma sp. infection has been shown to interact with HIV-1 by modifying susceptibility to the virus and impacting AIDS outcome, but very little is known about the potential impact of Schistosoma sp. infection on the efficiency of antiretroviral treatment (ART) in HIV-1 infected individuals. One study suggested increased immunological failure in patients infected with schistosomes compared to those uninfected. To our knowledge, no report exists on the virological response to ART in schistosome-infected individuals. In addition, viral load in HIV-1 infected individuals changes over the course of the HIV infection. This study assessed the impact of HIV-1/Schistosoma sp. co-infections on viral load in people with immunological failure on ART, taking into account the duration of HIV-1 infection.
We enrolled HIV-1 infected Tanzanian adults over 18 years of age who had used first line ART for more than 6 months and were identified to have immunological failure by the WHO criteria (50% drop from peak CD4 count, or CD4 count equal to or below baseline after 6 months of ART, or CD4 count below 100cells/mm after 1 year of ART). Patients were also tested for schistosome infection by microscopy for ova in urine and stool and by circulating anodic antigen (CAA) levels in serum. The duration of HIV-1 infection was calculated using baseline CD4+ T-cell (CD4) counts determined at enrollment. Univariable and multivariable analyses were conducted to compare viral loads in schistosome infected and uninfected patients.
A total of 188 patients were enrolled. After univariable analysis, female sex, lower peak CD4 counts, lower current CD4 counts, anemia, and shorter time infected with HIV-1 were all significantly associated with higher viral load. Schistosome infection was not associated with viral load even after adjusting for sex, current CD4 counts and duration of HIV-1 infection.
The current study of HIV-infected patients with immunological failure on ART suggests that once ART is introduced, ART is the dominant driver of viral load and schistosome infection may no longer have an impact.
已证实血吸虫感染会通过改变对病毒的易感性和影响艾滋病的结果来与 HIV-1 相互作用，但对于血吸虫感染对 HIV-1 感染者抗逆转录病毒治疗（ART）效率的潜在影响知之甚少。一项研究表明，与未感染者相比，感染血吸虫的患者免疫失败的发生率更高。据我们所知，尚无关于感染血吸虫的个体对 ART 的病毒学反应的报告。此外，HIV-1 感染者的病毒载量会在 HIV 感染过程中发生变化。本研究评估了 HIV-1/血吸虫混合感染对接受 ART 免疫失败的个体病毒载量的影响，同时考虑了 HIV-1 感染的持续时间。
我们招募了年龄在 18 岁以上的感染 HIV-1 的坦桑尼亚成年人，这些成年人已经接受了一线 ART 治疗超过 6 个月，并根据世界卫生组织的标准（峰值 CD4 计数下降 50%，或在 ART 治疗 6 个月后 CD4 计数等于或低于基线，或在 ART 治疗 1 年后 CD4 计数低于 100 个细胞/mm）确定免疫失败。还通过尿液和粪便镜检检测卵和血清中循环阴离子抗原（CAA）水平来检测血吸虫感染。使用入组时的基线 CD4+T 细胞（CD4）计数计算 HIV-1 感染的持续时间。进行单变量和多变量分析，以比较感染和未感染血吸虫的患者的病毒载量。
共纳入 188 例患者。单变量分析后，女性、较低的峰值 CD4 计数、较低的当前 CD4 计数、贫血和 HIV-1 感染时间较短均与较高的病毒载量显著相关。即使在校正了性别、当前 CD4 计数和 HIV-1 感染持续时间后，血吸虫感染与病毒载量也没有关联。
本研究对接受 ART 免疫失败的 HIV 感染者的研究表明，一旦引入 ART，ART 是病毒载量的主要驱动因素，而血吸虫感染可能不再有影响。
