The influence of different helminth infection phenotypes on immune responses against HIV in co-infected adults in South Africa

<p>Abstract</p> <p>Background</p> <p>The convergent distribution of the Human Immunodeficiency Virus (HIV) and helminth infections has led to the suggestion that infection with helminths exacerbates the HIV epidemic in developing countries. In South Africa, it is estimated that 57% of the population lives in poverty and carries the highest burden of both HIV and helmith infections, however, the disease interactions are under-researched.</p> <p>Methods</p> <p>We employed both coproscopy and <it>Ascaris lumbricoides</it>-specific serum IgE to increase diagnostic sensitivity and to distinguish between different helminth infection phenotypes and their effects on immune responses in HIV co-infected individuals. Coproscopy was done by formol ether and Kato Katz methods. HIV positive and negative adults were stratified according to the presence or absence of <it>A. lumbricoides </it>and/or <it>Trichuris trichuria </it>eggs with or without elevated <it>Ascaris </it>IgE. Lymphocyte subsets were phenotyped by flow cytometry. Viral loads, serum total IgE and eosinophils were also analysed. Lymphocyte activation markers (CCR5, HLA-DR, CD25, CD38 and CD71) were determined. Non parametric statistics were used to describe differences in the variables between the subgroups.</p> <p>Results</p> <p>Helminth prevalence ranged between 40%-60%. Four distinct subgroups of were identified, and this included egg positive/high <it>Ascaris</it>-specific IgE (egg⁺IgE^hi), egg positive/low IgE (egg⁺IgE^lo), egg negative/high IgE (egg^-IgE^hi) and egg negative/low IgE (egg^-IgE^lo) individuals. The egg⁺IgE^hisubgroup displayed lymphocytopenia, eosinophilia, (low CD4⁺counts in HIV^-group), high viral load (in HIV⁺group), and an activated lymphocyte profile. High <it>Ascaris </it>IgE subgroups (egg⁺IgE^hiand egg^-IgE^hi) had eosinophilia, highest viral loads, and lower CD4⁺counts in the HIV^-group). Egg excretion and low IgE (egg⁺IgE^lo) status demonstrated a modified Th₂immune profile with a relatively competent response to HIV.</p> <p>Conclusions</p> <p>People with both helminth egg excretion and high <it>Ascaris</it>-IgE levels had dysregulated immune cells, high viral loads with more immune activation. A modified Th₂helminth response in individuals with egg positive stools and low <it>Ascaris </it>IgE showed a better HIV related immune profile. Future research on helminth-HIV co-infection should include parasite-specific IgE measurements in addition to coproscopy to delineate the different response phenotypes. Helminth infection affects the immune response to HIV in some individuals with high IgE and egg excretion in stool.</p

Near vision correction and quality of life among textile factory workers in Durban

Background: Uncorrected near vision impairment affects the performance of near vision tasks and activities for an estimated 410 million people worldwide. Once normal vision becomes blurred or impaired, the ordinary and simple daily routines of individuals become difficult; often resulting in frustration and irritation, which is consequently reflected in their quality of life. Aim: We investigated the change of vision-related quality of life (VRQoL) following near correction among textile factory workers in South Africa. Methods: Presbyopic subjects who were 40 years and older with no other eye conditions were provided near spectacle correction. We interviewed subjects to ascertain their VRQoL scores using the National Eye Institute Visual Function Questionnaire, pre-treatment and 6 months after the provision of near corrections. Setting: The study was conducted among the textile factory workers in KwaZulu-Natal, South Africa. Results: A total of 423 textile factory workers were followed up from seven textile factories in Durban. The overall increase in VRQoL scores of 21.9 (95% CI 16.7–27) was significant (p < 0.01). This translates to a 36.5% (95% CI 30.6–42.4) change in VRQoL. The increase was highest among participants of African origin 25.1 (95% CI 21.14–29.1), males 18.8 (95% CI 12.6–27.2), among those who had completed primary school 35.8 (95% CI 21.7–49.9) and among participants with other responsibilities (ironing and quality assurance) 21.9 (95% CI 16.7–27). Conclusion: Correcting near vision impairment improved the VRQoL scores of textile factory workers. The results showed that VRQoL scores increased significantly across levels of education and categories of responsibilit