Department of Epidemiology, University of Washington, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
J Int AIDS Soc. 2020 Jun;23(6):e25534. doi: 10.1002/jia2.25534.
Globally, schistosomes infect approximately 200 million people, with 90% of infections in sub-Saharan Africa. Schistosomiasis is hypothesized to increase HIV-1 acquisition risk, and multiple cross-sectional studies reported strong associations. We evaluated this hypothesis within four large prospective cohorts.
We conducted nested case-control analyses within three longitudinal cohorts of heterosexual HIV-1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow-up from 1993 to 2014. Cases HIV-1 seroconverted during prospective follow-up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment.
We included 245 HIV-1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV-1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV-1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species-specific effects, there was no statistically significant association between HIV-1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection.
Schistosomiasis was not a strong risk factor for HIV-1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV-1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV-1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.
在全球范围内，有 2 亿人感染血吸虫病，其中 90%的感染发生在撒哈拉以南非洲。血吸虫病被认为会增加 HIV-1 的感染风险，并且多项横断面研究报告了强烈的关联。我们在四个大型前瞻性队列中评估了这一假设。
我们在来自肯尼亚和乌干达的三个异性恋 HIV-1 血清不一致夫妇的纵向队列和一个女性性工作者（FSW）队列中进行了嵌套病例对照分析。血清不一致的夫妇研究于 2004 年至 2012 年进行，而 FSW 队列的分析包括 1993 年至 2014 年的参与者随访。病例在前瞻性随访中 HIV-1 血清转化；每个病例选择三名对照。在 HIV-1 血清转化之前收集的存档血清中循环阳极抗原的存在确定了活动性血吸虫病患者；免疫印迹确定了血吸虫种类。来自血清不一致夫妇队列的数据被汇总，而 FSW 队列则单独进行分析，以进行适当的混杂因素调整。
我们纳入了来自血清不一致夫妇队列的 245 名 HIV-1 血清转化者和 713 名对照者，以及来自 FSW 队列的 330 名 HIV-1 血清转化者和 962 名对照者。血清不一致夫妇队列中活动性血吸虫病的患病率为 20%，FSW 队列中为 22%。我们没有发现血吸虫病与男性（调整后的优势比[aOR] 0.99，95%置信区间[CI] 0.59 至 1.67）或女性（aOR 1.21，95% CI 0.64 至 2.30）中 HIV-1 获得风险之间存在关联。同样，在 FSW 队列中，我们也未发现相关性（调整后的发病率比[aIRR] 1.11，95% CI 0.83 至 1.50）。探讨血吸虫种类特异性效应，HIV-1 获得风险与曼氏血吸虫（血清不一致夫妇：aOR 0.90，95% CI 0.56 至 1.44；FSW：aIRR 0.83，95% CI 0.53 至 1.20）或埃及血吸虫（血清不一致夫妇：aOR 1.06，95% CI 0.46 至 2.40；FSW：aIRR 1.64，95% CI 0.93 至 2.87）感染之间没有统计学显著关联。
在这四项前瞻性研究中，血吸虫病不是 HIV-1 获得的强危险因素。这些队列中大多数血吸虫病是由曼氏血吸虫引起的，我们的结果不支持曼氏血吸虫感染与 HIV-1 获得风险增加相关的假设。FSW 队列中埃及血吸虫感染与 HIV-1 风险的估计值呈正相关，但无统计学意义，而血清不一致夫妇队列中没有呈正相关的趋势。
