Filarial antigenemia and Loa loa night blood microfilaremia in an area without bancroftian filariasis in the democratic republic of Congo

Implementation of mass drug administration for lymphatic filariasis (LF) has been delayed in central Africa because of incomplete mapping and coendemic loiasis. We mapped two regions in eastern Democratic Republic of Congo that were suspected to have LF. Night blood samples were collected from 2,724 subjects in 30 villages. Filarial antigenemia rates by card test exceeded 1% in 28 villages (range = 0–14%). Prevalence rates for large sheathed microfilariae (Mf) ranged from 4% to 40%; Mansonella perstans rates ranged from 22% to 98%. Large Mf were exclusively Loa loa by microscopy, and only 1 of 337 samples tested by quantitative polymerase chain reaction (qPCR) was positive for Wuchereria bancrofti DNA. Filarial antigen positivity was strongly associated with high L. loa Mf counts. Periodicity studies revealed atypical patterns, with no significant diurnal periodicity in some individuals. Thus, methods routinely used for LF mapping may not be reliable in areas in central Africa that are highly endemic for loiasis

Baseline characteristics of 305 HIV-infected, Tanzanian adults on antiretroviral therapy (ART) at Bugando Medical Centre and comparison between patients on ART 3–6 months (GROUP 1) or >36 months (GROUP 2).

<p>Baseline characteristics of 305 HIV-infected, Tanzanian adults on antiretroviral therapy (ART) at Bugando Medical Centre and comparison between patients on ART 3–6 months (GROUP 1) or >36 months (GROUP 2).</p

Factors associated with hepatotoxicity in patients on ART in Tanzania.

<p>Factors associated with hepatotoxicity in patients on ART in Tanzania.</p

Increased hepatotoxicity among HIV-infected adults co-infected with <i>Schistosoma mansoni</i> in Tanzania: A cross-sectional study

<div><p>Introduction</p><p>Little is known about hepatotoxicity in patients with schistosome and HIV co-infections. Several studies have reported increased liver enzymes and bilirubin levels associated with schistosome infection. We investigated whether HIV-infected adults on antiretroviral therapy who had <i>S</i>. <i>mansoni</i> co-infection had a higher prevalence of hepatotoxicity than those without.</p><p>Methodology/Principal findings</p><p>We determined the presence and grade of hepatotoxicity among 305 HIV-infected outpatients who had been on medium-term (3–6 months) and long-term (>36 months) antiretroviral therapy in a region of northwest Tanzania where <i>S</i>. <i>mansoni</i> is hyperendemic. We used the AIDS Clinical Trial Group definition to define mild to moderate hepatotoxicity as alanine aminotransferase, alanine aminotransferase, and/or bilirubin elevations of grade 1 or 2, and severe hepatotoxicity as any elevation of grade 3 or 4. We determined schistosome infection status using the serum circulating cathodic antigen rapid test and used logistic regression to determine factors associated with hepatotoxicity. The prevalence of mild-moderate and severe hepatotoxicity was 29.6% (45/152) and 2.0% (3/152) in patients on medium-term antiretroviral therapy and 19.6% (30/153) and 3.3% (5/153) in the patients on long-term antiretroviral therapy. <i>S</i>. <i>mansoni</i> infection was significantly associated with hepatotoxicity on univariable analysis and after controlling for other factors associated with hepatotoxicity including hepatitis B or C and anti-tuberculosis medication use (adjusted odds ratio = 3.0 [1.6–5.8], p = 0.001).</p><p>Conclusions/Significance</p><p>Our work demonstrates a strong association between <i>S</i>. <i>mansoni</i> infection and hepatotoxicity among HIV-infected patients on antiretroviral therapy. Our study highlights the importance of schistosome screening and treatment for patients starting antiretroviral therapy in schistosome-endemic settings. Additional studies to determine the effects of schistosome-HIV co-infections are warranted.</p></div