Malaria and helminthic co-infection among HIV-positive pregnant women: Prevalence and effects of antiretroviral therapy
Graphical abstract
Helminth and malaria co-infection was higher in HIV-positive pregnant Rwandans in rural than in peri-urban areas. d4T–3TC–NVP regimen reduced the risk of helminth infection compared with AZT–3TC–NVP.
Highlights
► Prevalence of helminth, malaria and dual-infection was 38%, 21%, and 10%, respectively. ► Helminth infection was characterized by lower hemoglobin and CD4 cell counts. ► Helminth infection was more common in rural than peri-urban areas. ► Helminth caused greater prevalence of detectable viral load than no infection. ► d4T–3TC–NVP therapy caused fewer helminth and dual infection than AZT–3TC–NVP.
Introduction
Helminth and malaria infections have been hypothesized to be factors likely to be driving the HIV-1 epidemic in Africa (Harms and Feldmeier, 2002, Slutsker and Marston, 2007). Globally, there are more than 2 billion people that are estimated to be infected with soil-transmitted helminths, with the geographical distribution of these infections overlapping considerably with regions of high HIV-1 sero-prevalence and malaria endemicity (Fincham et al., 2003, Hotez and Kamath, 2009). Malaria and helminth infections play a role in the pathogenesis of HIV-1 infection in Africa, due to their profound effects on the host immune system, which makes those infected more susceptible to HIV-1 infection (Harms and Feldmeier, 2002, Korenromp et al., 2005).
The combination of HIV, helminthic and plasmodial infection in the host creates an immunologically complex profile (Gallagher et al., 2005) and substantially increases the risk of anemia, which is caused by all three types of infections (Laufer et al., 2006). Therefore, in terms of co-infection with these diseases, pregnant women in sub-Saharan Africa represent a highly vulnerable group, particularly in light of data showing that helminth infection increases the risk of mother-to-child transmission of HIV (Gallagher et al., 2005).
Recent data on the prevalence of helminth infection in Rwanda for school-going children from eight districts indicated a prevalence of 64.5%. The observed prevalence was higher in rural than in urban settings (Mupfasoni et al., 2009). However, no studies have documented the prevalence of malaria and intestinal helminth dual infections among pregnant women with HIV/AIDS attending antenatal services in the setup of ARV roll-out programs. Therefore, the aim of this study was to determine the baseline prevalence of helminth and malaria dual infections in HIV-1 infected pregnant women attending Rwandan health centers after ART initiation.
Section snippets
Study area and population
Participants were enrolled among women attending the antenatal health center clinics in the provinces of Ruhuha, Mareba and Biryogo. After having given written informed consent, women in the second and third trimester of pregnancy were enrolled into the study. Women were excluded if they were HIV negative, below 18 years of age, had clinical evidence of TB, and had a treatment history of antihelminthic therapy and clinical confirmation of an abnormal pregnancy. On enrolment, subjects were
Participants’ characteristics
The study cohort of 328 pregnant women included 166 from rural and 162 from peri-urban centers. The median [interquartile range] age of the cohort was 27.0 [8] years with no significant difference in age between the 2 population groups. The mean BMI (±SD) of the total cohort was 25.4 ± 3.44 with women from the peri-urban (26.7 ± 2.88) group being significantly heavier than the rural (24.1 ± 3.46; p < 0.0001) population. Study participants were recruited to the study in the second and third trimesters
Discussion
The current study shows that helminth and malaria infection levels in HIV-positive pregnant women are high and that malaria and malaria–helminth dual infection are more common in rural than urban areas. Malaria–helminth dual infection was found to be a risk factor for reduced BMI, whilst helminth infection either on its own or in conjunction with malaria was found to lead to lower hemoglobin and CD4 levels. The ARV regimen of d4T, 3TC and NVP was found to significantly reduce the risk of T.
Disclosure
None of the authors has any conflict of interest to declare.
Role of the funding source
This study received financial assistance from the Government of Rwanda through the Ministry of Education Student Financing Agency of Rwanda [SFAR] and supplementary funding from the World Health Organization Special Programme for Training and Research on Tropical Diseases. None of the funding sources was involved in study design, collection, analysis and interpretation of the data, in the writing of the paper or in the decision to submit the paper for publication.
Acknowledgments
We acknowledge all participants for their valuable time and commitment to participate in the study, and we thank the staff of the health centers where the study was carried for their help with patient enrolment and appointments. We particularly acknowledge all the research staff for their contribution to this study.
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