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.
University of Minnesota Ph.D. dissertation. April 2017. Major: Epidemiology. Advisors: David Boulware, Claudia Munoz-Zanzi. 1 computer file (PDF); xii, 125 pages.
Human Immunodeficiency Virus and Soil Transmitted Helminths: Measuring the Systemic Effects of Co-Infection in a Low-Resource Context.
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