Research Article: Treatment of W. bancrofti (Wb) in HIV/Wb Coinfections in South India

Date Published: March 20, 2015

Publisher: Public Library of Science

Author(s): Kawsar R. Talaat, Subash Babu, Pradeep Menon, N. Kumarasamy, Jabin Sharma, Jeeva Arumugam, Kalaivani Dhakshinamurthy, Ramalingam Srinivasan, S. Poongulali, Wenjuan Gu, Michael P. Fay, Soumya Swaminathan, Thomas B. Nutman, Zvi Bentwich.

Abstract: BackgroundThe disease course of human immunodeficiency virus (HIV) is often altered by existing or newly acquired coincident infections.Methodology/Principal FindingsTo assess the influence of pre-existing Wuchereria bancrofti infection on HIV progression, we performed a case-controlled treatment study of HIV positive individuals with (FIL+) or without (FIL-) W. bancrofti infection. Twenty-eight HIV+/FIL+ and 51 matched HIV+/FIL- subjects were treated with a single dose of diethylcarbamazine and albendazole (DEC/Alb) and followed for a year at regular intervals. Sixteen of the HIV+/FIL+ subjects (54%) and 28 of the HIV+/FIL- controls (57%) were on antiretroviral therapy (ART) during the study. Following treatment, no differences were noted in clinical outcomes between the 2 groups. There also was no significant difference between the groups in the HIV viral load at 12 months as a percentage of baseline viral load (HIV+/FIL+ group had on average 0.97 times the response of the HIV+/FIL- group, 95% CI 0.88, 1.07) between the groups. Furthermore, there were no significant differences found in either the change in viral load at 1, 3, or 6 months or in the change in CD4 count at 3, 6, or 12 months between the 2 groups.Conclusions/SignificanceWe were unable to find a significant effect of W. bancrofti infection or its treatment on HIV clinical course or surrogate markers of HIV disease progression though we recognized that our study was limited by the smaller than predicted sample size and by the use of ART in half of the patients. Treatment of W. bancrofti coinfection in HIV positive subjects (as is usual in mass drug administration campaigns) did not represent an increased risk to the subjects, and should therefore be considered for PLWHA living in W. bancrofti endemic areas.Trial NCT00344279

Partial Text: As the HIV epidemic continues in many parts of the world, more attention is being focused on strategies for prevention and management of HIV infection. In addition to highly active antiretroviral therapy (ART), the immune interactions between HIV and non-HIV co-infections have been examined. Several groups have examined the interaction of helminth infections with HIV, and many of these studies have been recently reviewed[1–3]. Some studies have shown that patients with HIV and concomitant helminth infections have higher viral loads which decrease upon anthelmintic treatment [4,5] whereas others have shown no effect of coincident helminth infections on viral load, CD4 count or HIV disease progression [6–9].

In this study, we attempted to look at the progression of HIV disease in patients with W. bancrofti/HIV co-infection compared with those with HIV alone after a one-time treatment with DEC/Alb, the standard therapy used worldwide (except in Africa) for mass drug administration programs. In addition, we also looked at biomarkers as surrogates for disease progression (CD4 count, viral load). We found no difference in the clinical outcomes of the subjects one year after treatment. We did find a transient and significant increase in viral loads in those Wb/HIV co-infected subjects not on ART after 1 month, though this difference in VLs between the Wb-infected and -uninfected HIV+ subjects equalized for the remainder of the study. When we examined CD4 counts at 3, 6 and 12 months, or viral loads and hemoglobin values at 1, 3, 6, and 12 months we found no difference between the 2 groups with the exception of higher hemoglobin values in the co-infected group at 1 year. The protective effect of filarial infection on infection-related anemia is lent support by a study of filarial/malaria co-infection in Africa [22].



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