Treatment of W. bancrofti (Wb) in HIV/Wb Coinfections in South India

Background: The disease course of human immunodeficiency virus (HIV) is often altered by existing or newly acquired coincident infections. Methodology/Principal Findings: To assess the influence of pre-existing Wuchereria bancrofti infection on HIV progression, we performed a case-controlled treatment study of HIV positive individuals with (FIL+) or without (FIL-) W. bancrofti infection. Twenty-eight HIV+/FIL+ and 51 matched HIV+/FIL- subjects were treated with a single dose of diethylcarbamazine and albendazole (DEC/Alb) and followed for a year at regular intervals. Sixteen of the HIV+/FIL+ subjects (54%) and 28 of the HIV+/FIL- controls (57%) were on antiretroviral therapy (ART) during the study. Following treatment, no differences were noted in clinical outcomes between the 2 groups. There also was no significant difference between the groups in the HIV viral load at 12 months as a percentage of baseline viral load (HIV+/FIL+ group had on average 0.97 times the response of the HIV+/FIL- group, 95% CI 0.88, 1.07) between the groups. Furthermore, there were no significant differences found in either the change in viral load at 1, 3, or 6 months or in the change in CD4 count at 3, 6, or 12 months between the 2 groups. Conclusions/Significance: We were unable to find a significant effect of W. bancrofti infection or its treatment on HIV clinical course or surrogate markers of HIV disease progression though we recognized that our study was limited by the smaller than predicted sample size and by the use of ART in half of the patients. Treatment of W. bancrofti coinfection in HIV positive subjects (as is usual in mass drug administration campaigns) did not represent an increased risk to the subjects, and should therefore be considered for PLWHA living in W. bancrofti endemic areas

CD4 counts and hemoglobin levels over time.

<p>CD4 counts (<b>A</b> and <b>B</b>) and Hemoglobin levels (Hgb) (<b>C</b> and <b>D</b>) at baseline and 1 year between HIV+ /FIL+ individuals (<b>A</b>, <b>C</b>) and HIV+/FIL- individuals (<b>B</b>, <b>D</b>). <b>E</b>. Hemoglobin percent change at 1 year between HIV+/FIL+ and HIV+/FIL- individuals.</p

A. <i>Wuchereria bancrofti</i> antigen and antibody levels over time.

<p>Circulating <i>Wuchereria bancrofti</i> antigen levels in HIV+/FIL+ individuals at baseline and 1 year. <b>B</b>. BMA-specific IgG in HIV+/FIL+ subjects at baseline and 1 year. <b>C</b>. Total IgG4 levels in HIV+/FIL+ subjects at baseline and 1 year.</p

HIV viral load by over time by individual.

<p>HIV VL at baseline and 1 year in HIV+ /FIL+ individuals (<b>A</b>) and HIV+/FIL- individuals (<b>B</b>).</p

CD4 count and viral load comparisons at baseline and 1 year.

<p>Comparison of CD4 and viral load (VL) at baseline (<b>A</b> CD4 [count/dL]), <b>B</b> log VL [log₁₀ RNA Copies]) and at 1 year (<b>C</b> CD4 count, <b>D</b> log VL) between HIV+/FIL+ cases and HIV+/FIL- controls.</p

Consort diagram.

<p>Consort diagram.</p

Demographics.

<p>Abbreviations: HIV: Human Immunodeficiency Virus; FIL: Filaria (<i>W</i>. <i>bancrofti</i> antigen) positive; GM: geometric mean; SD: standard deviation; WMW: Wilcoxon-Mann-Whitney; ART: highly active antiretroviral therapy, N/A: Not available; %: percent. Hgb: Hemoglobin (gm/dL); WBC: White blood cell count (x 10³/mm³); EOS: eosinophils; Plts: platelet count (x10³/uL); ALT: alanine transaminase (SGPT, IU/L); AST: aspartate transaminase (SGOT, IU/L); VL: viral load; Ag: antigen.</p><p>^ 52 subjects were enrolled, but 1 subject did not have baseline HIV viral load value done. These statistics are on all 52 except for the viral load.</p><p>* In addition to the 28 subjects who got ART throughout, there were 2 (3.8%) subjects who got ART only part of the time during the study. Fisher’s exact test excluded those 2 subjects.</p><p>^$ Measured on only n = 12 in the HIV+/FIL+ group and n = 39 in the HIV+/FIL- group.</p><p>Demographics.</p

Treatment of W. bancrofti (Wb) in HIV/Wb Coinfections in South India

BACKGROUND:The disease course of human immunodeficiency virus (HIV) is often altered by existing or newly acquired coincident infections. METHODOLOGY/PRINCIPAL FINDINGS:To assess the influence of pre-existing Wuchereria bancrofti infection on HIV progression, we performed a case-controlled treatment study of HIV positive individuals with (FIL+) or without (FIL-) W. bancrofti infection. Twenty-eight HIV+/FIL+ and 51 matched HIV+/FIL- subjects were treated with a single dose of diethylcarbamazine and albendazole (DEC/Alb) and followed for a year at regular intervals. Sixteen of the HIV+/FIL+ subjects (54%) and 28 of the HIV+/FIL- controls (57%) were on antiretroviral therapy (ART) during the study. Following treatment, no differences were noted in clinical outcomes between the 2 groups. There also was no significant difference between the groups in the HIV viral load at 12 months as a percentage of baseline viral load (HIV+/FIL+ group had on average 0.97 times the response of the HIV+/FIL- group, 95% CI 0.88, 1.07) between the groups. Furthermore, there were no significant differences found in either the change in viral load at 1, 3, or 6 months or in the change in CD4 count at 3, 6, or 12 months between the 2 groups. CONCLUSIONS/SIGNIFICANCE:We were unable to find a significant effect of W. bancrofti infection or its treatment on HIV clinical course or surrogate markers of HIV disease progression though we recognized that our study was limited by the smaller than predicted sample size and by the use of ART in half of the patients. Treatment of W. bancrofti coinfection in HIV positive subjects (as is usual in mass drug administration campaigns) did not represent an increased risk to the subjects, and should therefore be considered for PLWHA living in W. bancrofti endemic areas. TRIAL REGISTRATION:ClinicalTrials.gov NCT00344279