Antihelminthics in helminth-endemic areas: effects on HIV disease progression

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Arianna Rubin Means1, Paul Burns1, David Sinclair2, Judd L Walson3

1. University of Washington, Department of Global Health, Seattle, Washington, USA
2. Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
3. University of Washington, Departments of Global Health, Medicine (Infectious Disease) and Pediatrics, Epidemiology, Seattle, WA, USA

Means AR, Burns P, Sinclair D, Walson JL. Antihelminthics in helminth-endemic areas: effects on HIV disease progression. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD006419. DOI: 10.1002/14651858.CD006419.pub4.

To read the full review please follow this link: DOI: 10.1002/14651858.CD006419.pub4

Antihelminthics in helminth endemic areas: effects on HIV infection

This Cochrane Review summarizes trials that evaluated the benefits and potential risks of providing deworming drugs (antihelminthics) to people infected with human immunodeficiency virus (HIV). After we searched for relevant trials up to 29 September 2015 we included eight trials that enrolled 1612 participants.

What are deworming drugs and why might they delay HIV disease progression

Deworming drugs are used to treat a variety of human helminth infections, such as soil-transmitted helminths, schistosomiasis, onchocerciasis, and lymphatic filariasis. In areas where these infections are common, the World Health Organization currently recommends that targeted populations are routinely treated every six to 12 months without prior confirmation of an individual's infection status. The use of empiric therapy, or treating all at-risk populations presumptively, is preferred to test-and-treat strategies because deworming drugs are inexpensive and well tolerated. Additionally, a strategy of testing before treatment is considered less cost-effective given that available diagnostic tests are relatively expensive and can exhibit poor sensitivity.

Helminth infections are known to affect the human immune system. In people with HIV, some studies have suggested that helminth infections may reduce the number of CD4+ cells (which are a critical part of the immune response to HIV) and compromise a person's ability to control HIV viral replication. Thus, treatment of helminth infections could have important benefits for people living with HIV beyond the benefits observed in the general population as a result of deworming.

What the evidence in this review suggests

Treating all HIV-positive adults with deworming drugs without knowledge of their helminth infection status may have a small suppressive effect on viral load at six weeks (low quality evidence), but repeated dosing over two years appears to have little or no effect on either viral load (moderate quality evidence) or CD4+ cell count (low quality evidence). These findings are based on two included studies.

Providing deworming drugs to HIV-positive adults with diagnosed helminth infection may result in a small suppressive effect on mean viral load at six to 12 weeks (low quality evidence) and a small favourable effect on mean CD4+ cell count at 12 weeks (low quality evidence). However, these findings are based on small studies and are strongly influenced by a single study of praziquantel for schistosomiasis. Further studies from different settings and populations are needed for confirmation.

Adverse events were not well reported (very low quality evidence), and trials were too small to evaluate the effects on mortality (low quality evidence). However there is no suggestion that deworming drugs are harmful for HIV-positive individuals.

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