Schistosomiasis is associated with incident HIV transmission and death in Zambia

• Type of Material: Article
• Authors: Kristin Wall, Emory University; William Kilembe, Emory University; Bellington Vwalika, Emory University; Cecile Dinh, Emory University; Paul Livingston, Emory University; Yeuk-Mui Lee, Centers for Disease Control and Prevention; Shabir Lakhi, Emory University; Debi Boeras, Emory University; Htee Khu Naw, Emory University; Ilene Brill, Emory University; Elwyn Chomba, Emory University; Tyronza Sharkey, Emory University; Rachel Parker, Emory University; Erin Shutes, Bill & Melinda Gates Foundation; Amanda Tichacek, Emory University; W. Evan Secor, Centers for Disease Control and Prevention; Susan Allen, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2018, Public Library of Science. All rights reserved.
• License: Creative Commons Creative Commons CC0 1.0 Universal
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pntd.0006902
• Title of Journal or Parent Work: PLoS Neglected Tropical Diseases
• ISSN: 1935-2727
• Volume: 12
• Issue: 12
• Start Page: e0006902
• End Page: e0006902
• Grant/Funding Information: The contents do not necessarily reflect the views of USAID, CDC, or the United States Government.; This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID).; The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.; This work was supported by the Bill and Melinda Gates Foundation [Grant ID 1005342], the National Institute of Child Health and Development [NICHD R01 HD40125]; National Institute of Mental Health [NIMH R01 66767]; the AIDS International Training and Research Program Fogarty International Center [D43 TW001042]; the Emory Center for AIDS Research [P30 AI050409]; National Institute of Allergy and Infectious Diseases [NIAID R01 AI51231, NIAID R01 AI040951, NIAID R01 AI023980, NIAID R01 AI64060, NIAID R37 AI51231]; the US Centers for Disease Control and Prevention [5U2GPS000758]; and the International AIDS Vaccine Initiative.
• Keywords: PREVALENCE; Science & Technology; Life Sciences & Biomedicine; IMMUNODEFICIENCY-VIRUS TYPE-1; MANSONI; Parasitology; HAEMATOBIUM; Infectious Diseases; LUSAKA; RURAL ZIMBABWE; Tropical Medicine; DISCORDANT COUPLES; RISK; INFECTION; FEMALE GENITAL SCHISTOSOMIASIS
• Research Categories: Health Sciences, Obstetrics and Gynecology; Biology, Parasitology; Health Sciences, Epidemiology

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.