This work was supported by the Doris Duke Charitable Foundation International Clinical Research Fellowship at Harvard Medical School and the American Medical Association Foundation Seed Grant Research Program (AJL); U.S. National Institutes of Health [NIH] R24TW007988 and K23MH099916 (MJS); NIH K23MH087228 (JEH); NIH K24MH087227 (DRB); NIH K23MH096620 (ACT); and NIH U01 AI069911 and P30 AI027763 (JNM).
PLoS Neglected Tropical Diseases
Antiretroviral therapy, HIV infections -- Treatment -- Uganda, HIV infections -- Treatment -- South Africa, AIDS (Disease) -- Patients -- Effect of empiric deworming on, Pharmacoepidemiology -- Statistical methods
Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (‘‘deworming’’) in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naive individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.
Methodology/Principal Findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or nonreceipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (b = 42.8; 95% CI, 22.1 to 87.7) or after the first year of ART (b =29.9; 95% CI, 224.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (b = 63.0; 95% CI, 6.0 to 120.1) in females.
Conclusions/Significance: Empiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naive individuals, but suggest that certain sub-populations may benefit.
Public Library of Science
Lankowski AJ, Tsai AC, Kanyesigye M, Bwana M, Haberer JE, Wenger M, Martin JN, Bangsberg DR, Hunt PW, Siedner MJ. Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy. PLoS Negl Trop Dis. 2014 Aug; 8(8):e3036.