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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.

Author information

1
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.
2
Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, United States of America.
3
Department of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia.
4
Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
5
Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia.
6
Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
7
Ministry of Home Affairs, Zambian Ministry of Health, Lusaka, Zambia.
8
School of Medicine, University of Zambia, Lusaka, Zambia.
9
Malaria Team, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.

Abstract

BACKGROUND:

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

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

PMID:
30543654
PMCID:
PMC6292564
DOI:
10.1371/journal.pntd.0006902
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

The authors have declared that no competing interests exist.

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