Hookworm infection is associated with decreased CD4+T cell counts in HIV-infected adult Ugandans

Most studies evaluating epidemiologic relationships between helminths and hiv have been conducted in the pre-art era,and evidence of the impact of helminth infections on hiv disease progression remains conflicting. less is known about helminth infection and clinical outcomes in hiv-infected adults receiving antiretroviral therapy (art). we sampled hiv-infected adults for eight gastrointestinal parasites and correlated parasitic infection with demographic predictors,and clinical and immunologic outcomes. contrasting with previous studies,we measured parasitic infection with a quantitative,highly sensitive and specific polymerase chain reaction (pcr) method. this cohort study enrolled hiv-infected ugandans from august-september 2013 in mbale,uganda and collected stool and blood samples at enrollment. real-time pcr quantified stool: ascaris lumbricoides,ancylostoma duodenale,necator americanus,strongyloides stercoralis,trichuris trichiura,cryptosporidium spp.,entamoeba histolytica,and giardia intestinalis infection. generalized linear models assessed relationships between parasitic infection and clinical or demographic data. 35% of participants (71/202) tested positive for ≥1 helminth,mainly n. americanus (55/199,28%),and 4.5% (9/202) were infected with ≥2 stool parasites. participants with hookworm infection had lower average cd4+cell counts (-94 cells/mcl,95%ci: -141,-48 cells/mcl; p<0.001) after adjustment for sex,cd4+nadir at clinic entry,and time on art. the high prevalence of parasitic infection and correlation with decreased cd4+concentrations highlight the need to re-examine the effects of invasive helminth co-infection in rural,hiv-infected populations in the era of widely available art. elucidating the relationship between hookworm infection and immune recovery could provide opportunities for health optimization,e.g. integrated deworming,in these vulnerable populations. © 2017 morawski et al.