Prevalence of immunological failure and durability of first line antiretroviral therapy at Bugando Hospital Mwanza, Tanzania

Background: Highly active antiretroviral therapy (HAART) for the treatment of HIV infection has led to profound reductions in the incidence of mortality due to AIDS-related causes in recent years. Immunological status is common parameter used to monitor HIV treatment success in developing countries. This a crossectional retrospective follow up study was conducted to determine the prevalence of immunological treatment failure and risk factors associated to it among patients on ARV therapy at Bugando MedicalCentre. Method: A crossectional Retrospective study was conducted amongall patients on ART from 2005 attending BMC CTC clinic. Using standard data collection form all demographic data, adherence levels, and CD4 + counts were recorded and analyzed using SPSS 11.5 computer software to determine the prevalence and predictors of immunological failure. Results: A total of 2975 patients were on ART during the study period, in the analysis 362 patients were included and followed backwards for mean duration of 29 months. The base line CD4 of more than 100cells/μl was found in 43.6% of patients studied. A steady CD4 increase in the first 7 months, followed by slow increase in subsequent months was noted. The prevalence of immunological treatment failure was 17.1% (95% CI 17.1%±3.9). Adherence below 95% was strongly associated with immunological treatment failure (p=0.00001). There was significant association between baseline CD4 of more than 100cell/ μl and immunological treatment failure (p=0.001). No significant difference was found between Home based care (HBCP) and immunological treatment failure (p=0.06). The average time to treatment failure for the first line regimen was 20 months, with 59% of failed patients having a lag time of 5 weeks before appropriate changes in their ART regimen were done. Conclusions and recommendation: Immunological failure was significantly associated with adherence below 95% and low baseline CD4 count of less than 100cells/μl. The multi-disciplinary HIV treatment and care should reinforce adherence during each patient encounter. Strategies to maximise adherence will help to ensure treatment success. We also recommend early HIV testing and referral to care before severe immnosuppression develops. A switch to second line ARV regimen should be considered after a period of adherence intensification.Key words: Immunological failure, CD4, Prevalence, HAART, HI

Refining Diagnosis of Schistosoma haematobium Infections: Antigen and Antibody Detection in Urine

Host-parasite interactio

Detectable urogenital schistosome DNA and cervical abnormalities 6 months after single-dose praziquantel in women with Schistosoma haematobium infection

Host-parasite interactio

HIV-1 Viral Loads Are Not Elevated in Individuals Co-infected With Schistosoma spp. After Adjustment for Duration of HIV-1 Infection

Host-parasite interactio

Insufficiency of annual praziquantel treatment to control Schistosoma mansoni infections in adult women: A longitudinal cohort study in rural Tanzania

Background Current World Health Organization (WHO) guidelines recommend annual mass drug administration using praziquantel in areas with high schistosome endemicity. Yet little is known about incidence and reinfection rates after treatment in women with frequent exposure to schistosomes. We sought to quantify response to anti-schistosome treatment and incident S. mansoni infections in a cohort of rural women living in a schistosome-endemic area of northwest Tanzania. Methods and principal findings We enrolled women with and without S. mansoni infection into a 12-month longitudinal cohort. Every 3 months, women were tested for schistosome infection using microscopic examinations for ova on filtered urine, Kato Katz slides, and serum Circulating Anodic Antigen (CAA). Those with schistosome infection received treatment with praziquantel 40 mg/kg according to the standard of care. We studied 35 women who were S. mansoni positive by stool microscopy and 46 women without schistosome infection who returned for at least one follow-up. Of the women who were initially infected, 14 (40%) were schistosome-positive at a follow-up visit. Four women developed incident infections, for a cumulative incidence of 8.7% and incidence rate of 0.99 per 100 person-months throughout the year among initially uninfected women. Only 3 women were egg-positive at any follow-up. Women with persistent, recurrent, or incident infection during the study period were significantly younger (p = 0.032) and had fewer children than women who remained uninfected or those who cleared the infection and did not experience recurrence (p = 0.003). Having fewer children remained significant after controlling for age (p = 0.023). There was no difference in initial intensity of infection by CAA or stool egg count, HIV status, or socioeconomic status. Although most water contact behaviors were comparable between the two groups, women with recurrent or incident schistosome infections were significantly more likely to have recently swum in the lake (p = 0.023). Conclusions Our data suggests that annual praziquantel treatment reduces intensity of schistosome infections but is insufficient in providing stable parasite eradication in over a third of women in endemic communities. Furthermore, microscopy lacks adequate sensitivity to evaluate efficacy of treatment in this population. Our work demonstrates that further investigation into treatment efficacy and reinfection rates is warranted and suggests that increased frequency of praziquantel treatment is needed to improve cure rates in high-risk populations.Author summary Schistosomiasis is a parasitic infection transmitted through contaminated water that primarily affects the gastrointestinal and urogenital tracts. Previous studies in Tanzania have shown that adult women infected with schistosomes also have a higher risk of contracting HIV. Although it is recommended that people living in areas where they are exposed to schistosomes be treated with praziquantel once a year, the rate of new infections or reinfection after treatment in adult women is not known. We followed a group of schistosome-infected women and an uninfected control group for 12 months. They were tested for schistosomes every 3 months, and treated with praziquantel if they were infected. Over 40% of the women tested positive for schistosome infection at some point during the follow-up period, and the majority of them were from the group that was infected at the beginning of the study. These women may not have fully cleared the infection after one treatment, or they may be more susceptible to reinfection due to variations in their immune systems. Further studies are recommended to investigate whether a higher frequency of treatment is needed to control schistosome infection in adult women, especially given that reducing schistosome infection may help to reduce HIV risk in populations similar to ours.Host-parasite interactio

Schistosoma mansoni Infection Is Associated With Increased Monocytes and Fewer Natural Killer T Cells in the Female Genital Tract

Schistosoma mansoni infection may impair genital mucosal antiviral immunity, but immune cell populations have not been well characterized. We characterized mononuclear cells from cervical brushings of women with and without S mansoni infection. We observed lower frequencies of natural killer T cells and higher frequencies of CD14(+) monocytes in infected women.Cancer Signaling networks and Molecular Therapeutic

Schistosoma mansoni Infection Is Associated With Increased Monocytes and Fewer Natural Killer T Cells in the Female Genital Tract

Schistosoma mansoni infection may impair genital mucosal antiviral immunity, but immune cell populations have not been well characterized. We characterized mononuclear cells from cervical brushings of women with and without S mansoni infection. We observed lower frequencies of natural killer T cells and higher frequencies of CD14(+) monocytes in infected women

Gene Expression Differences in Host Response to Schistosoma haematobium Infection

Cancer Signaling networks and Molecular Therapeutic

Cervicovaginal bacterial communities in reproductive-aged Tanzanian women with Schistosoma mansoni, Schistosoma haematobium, or without schistosome infection

Schistosome infection is recognized as a potentially modifiable risk factor for HIV in women by the World Health Organization. Alterations in cervicovaginal bacteria have been associated with HIV acquisition and have not been studied in schistosome infection. We collected cervical swabs from Tanzanian women with and without S. mansoni and S. haematobium to determine effects on cervicovaginal microbiota. Infected women were treated, and follow-up swabs were collected after 3 months. 16S rRNA sequencing was performed on DNA extracted from swabs. We compared 39 women with S. mansoni with 52 uninfected controls, and 16 with S. haematobium with 27 controls. S. mansoni-infected women had increased abundance of Peptostreptococcus (p = 0.026) and presence of Prevotella timonesis (p = 0.048) compared to controls. High-intensity S. haematobium infection was associated with more diverse cervicovaginal bacterial communities than uninfected controls (p = 0.0159). High-intensity S. mansoni infection showed a similar trend (p = 0.154). At follow-up, we observed increased alpha diversity in S. mansoni (2.53 vs. 1.72, p = 0.022) and S. haematobium (2.05 vs. 1.12, p = 0.066) infection groups compared to controls. Modifications in cervicovaginal microbiota, particularly increased diversity and abundance of taxa associated with bacterial vaginosis and HIV (Peptostreptococcus, Prevotella), were associated with schistosome infection.Host-parasite interactio

Altered Cervical Mucosal Gene Expression and Lower Interleukin 15 Levels in Women With Schistosoma haematobium Infection but Not in Women With Schistosoma mansoni Infection

Host-parasite interactio