Human Immunodeficiency Virus and Soil Transmitted Helminths: Measuring the Systemic Effects of Co-Infection in a Low-Resource Context
2017-04
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Human Immunodeficiency Virus and Soil Transmitted Helminths: Measuring the Systemic Effects of Co-Infection in a Low-Resource Context
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2017-04
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The impacts of helminth infection and anthelmintic therapy among HIV-infected people in co-endemic areas remains unknown. Health effects are likely species-dependent, and each species may exert countervailing effects on its host. Furthermore, there is a dearth of high-quality research conducted in the era of widely available ART. Data from two studies conducted in Mbale, Uganda were used to: 1) estimate clinical correlates of helminth infection among HIV-infected Ugandans; 2) characterize fecal microbiome composition in these participants, and correlate clinical characteristics with microbiome composition; and 3) evaluate the impact of anthelmintic therapy on markers of systemic inflammation in HIV-infected Ugandans via a randomized control trial. Aim I uses molecular methods to describe the prevalence and burden of 5 soil-transmitted helminth species among patients in outpatient HIV care, and quantifies the relationship between baseline helminth infection and immune status. We observed a clinically significant inverse relationship between hookworm infection and CD4+ T cells/mcL. Aim II analyses the fecal microbiome of HIV-infected Ugandans to identify differences in community structure across clinical characteristics, and determine if gut community structure and/or taxa are associated with change in immune status over time. Our results indicate lower bacterial community richness among participants with <100 CD4+ T cells/mcL, and identify two taxa that may be linked to CD4+ T cell recovery. Aim III quantifies changes in soluble CD14, C-reactive protein, and 10 pro-inflammatory cytokines in ART-initiated Ugandans randomized to either immediate or delayed albendazole therapy. Our findings indicate low helminth infection prevalence (10%) and an increase in soluble CD14 after 1-month of follow-up among participants receiving immediate albendazole. These aims contribute to knowledge of clinical and sub-clinical correlates of helminth infection in the ART era. Results may support integration of anthelmintic therapy into adult HIV care, which is often overlooked when setting anthelmintic program priorities.
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University of Minnesota Ph.D. dissertation. April 2017. Major: Epidemiology. Advisors: David Boulware, Claudia Munoz-Zanzi. 1 computer file (PDF); xii, 125 pages.
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Morawski, Bozena. (2017). Human Immunodeficiency Virus and Soil Transmitted Helminths: Measuring the Systemic Effects of Co-Infection in a Low-Resource Context. Retrieved from the University Digital Conservancy, https://hdl.handle.net/11299/188922.
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