Estimated effects of age and sex on CD4+ cell count response to treatment.

<p>Points reflect fixed effects parameters estimated from a hierarchical asymptotic nonlinear mixed effects model with error bars indicating 95% confidence intervals. Numerical values given in Table C in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164148#pone.0164148.s001" target="_blank">S1 File</a>.</p

Asymptotic model diagram.

<p>Schematic diagram of the negative exponential asymptotic model of CD4+ cell recovery. Int, Asym and the half life (<i>t</i>_50%) represent the CD4+ cell count at initiation of antiretroviral treatment, the asymptotic CD4+ cell count and the time to reach 50% of the maximal CD4+ recovery, respectively.</p

Demographic characteristics and follow-up data of analyzed patients.

<p>Demographic characteristics and follow-up data of analyzed patients.</p

Initial CD4+ cell count and asymptotic CD4+ cell count by age and sex.

<p>For each sex and age grouping, these panels show estimated asymptotic CD4+ count versus estimated CD4+ count at treatment initiation, as fitted in the best fit asymptotic non-linear mixed effects regression model of CD4+ counts over time for patients within the outpatient monitoring system of the National AIDS Control Program in Tanzania. Each circle represents one patient. Blue lines show fitted linear regressions with value in bottom right of each panel showing the R² for this correlation.</p

Combined effectiveness of anthelmintic chemotherapy and WASH among HIV-infected adults

<div><p>Introduction</p><p>Current global helminth control guidelines focus on regular deworming of targeted populations for morbidity control. However, water, sanitation, and hygiene (WASH) interventions may also be important for reducing helminth transmission. We evaluated the impact of different potential helminth protective packages on infection prevalence, including repeated treatment with albendazole and praziquantel with and without WASH access.</p><p>Methodology/Principal findings</p><p>We conducted a cohort study nested within a randomized trial of empiric deworming of HIV-infected adults in Kenya. Helminth infections and infection intensity were diagnosed using semi-quantitative real-time PCR. We conducted a manual forward stepwise model building approach to identify if there are packages of interventions that may be protective against an STH infection of any species (combined outcome) and each helminth species individually. We conducted secondary analyses using the same approach only amongst individuals with no anthelmintis exposure. We used interaction terms to test for potential intervention synergy. Approximately 22% of the 701 stool samples provided were helminth-infected, most of which were of low to moderate intensity. The odds of infection with any STH species were lower for individuals who were treated with albendazole (aOR:0.11, 95%CI: 0.05, 0.20, p<0.001), adjusting for age and sex. Although most WASH conditions demonstrated minimal additional benefit in reducing the probability of infection with any STH species, access to safe flooring did appear to offer some additional protection (aOR:0.34, 95%CI: 0.20, 0.56, p<0.001). For schistosomiasis, only treatment with praziquantel was protective (aOR:0.30 95%CI: 0.14, 0.60, p = 0.001). Amongst individuals who were not treated with albendazole or praziquantel, the most protective intervention package to reduce probability of STH infections included safe flooring (aOR:0.34, 95%CI: 0.20, 0.59, p<0.001) and latrine access (aOR:0.59, 95%CI: 0.35, 0.99, p = 0.05). Across all species, there was no evidence of synergy or antagonism between anthelmintic chemotherapy with albendazole or praziquantel and WASH resources.</p><p>Conclusions/Significance</p><p>Deworming is effective in reducing the probability of helminth infections amongst HIV-infected adults. With the exception of safe flooring, WASH offers minimal additional benefit. However, WASH does appear to significantly reduce infection prevalence in adults who are not treated with chemotherapy.</p><p>Trial registration</p><p>ClinicalTrials.gov, <a target="_blank">NCT00507221</a>.</p></div

Optimal protective helminth interventions in adults without access to treatment identified through stepwise model building, by species (adjusted for sex and age) ¹.

<p>Optimal protective helminth interventions in adults without access to treatment identified through stepwise model building, by species (adjusted for sex and age) <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005955#t005fn001" target="_blank">¹</a>.</p

Participant (N = 701) characteristics (non-imputed).

<p>Participant (N = 701) characteristics (non-imputed).</p

Prevalent helminth infections.

<p>Prevalent helminth infections.</p

Intensity of prevalent helminth infections (percent of infections).

<p>Intensity of prevalent helminth infections (percent of infections).</p

Optimal protective helminth interventions identified through stepwise model building, by species (adjusted for sex and age)¹.

<p>Optimal protective helminth interventions identified through stepwise model building, by species (adjusted for sex and age)<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005955#t004fn001" target="_blank">¹</a>.</p