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PLoS Negl Trop Dis. 2018 Dec 13;12(12):e0006902. doi: 10.1371/journal.pntd.0006902. eCollection 2018 Dec.

Schistosomiasis is associated with incident HIV transmission and death in Zambia.

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Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America.
Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia.
Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia.
Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
Ministry of Home Affairs, Zambian Ministry of Health, Lusaka, Zambia.
School of Medicine, University of Zambia, Lusaka, Zambia.
Malaria Team, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.



We examined relationships between schistosome infection, HIV transmission or acquisition, and all-cause death.


We retrospectively tested baseline sera from a heterosexual HIV-discordant couple cohort in Lusaka, Zambia with follow-up from 1994-2012 in a nested case-control design. Schistosome-specific antibody levels were measured by ELISA. Associations between baseline antibody response to schistosome antigens and incident HIV transmission, acquisition, and all-cause death stratified by gender and HIV status were assessed. In a subset of HIV- women and HIV+ men, we performed immunoblots to evaluate associations between Schistosoma haematobium or Schistosoma mansoni infection history and HIV incidence.


Of 2,145 individuals, 59% had positive baseline schistosome-specific antibody responses. In HIV+ women and men, baseline schistosome-specific antibodies were associated with HIV transmission to partners (adjusted hazard ratio [aHR] = 1.8, p<0.005 and aHR = 1.4, p<0.05, respectively) and death in HIV+ women (aHR = 2.2, p<0.001). In 250 HIV- women, presence of S. haematobium-specific antibodies was associated with increased risk of HIV acquisition (aHR = 1.4, p<0.05).


Schistosome infections were associated with increased transmission of HIV from both sexes, acquisition of HIV in women, and increased progression to death in HIV+ women. Establishing effective prevention and treatment strategies for schistosomiasis, including in urban adults, may reduce HIV incidence and death in HIV+ persons living in endemic areas.

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Conflict of interest statement

The authors have declared that no competing interests exist.

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