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Deworming failed to delay HIV progression in helminth coinfections
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Recent data published in The Lancet Infectious Diseases suggest that empiric deworming did not delay HIV disease progression in patients coinfected with helminths.
“Although some studies have shown that deworming HIV-infected adults with worms may have some benefit in delaying HIV disease progression, this large study did not find evidence of such benefit when a large population was empirically dewormed,” Judd Walson, MD, MPH, of the departments of Global Health and Medicine at the University of Washington, told Infectious Disease News. “This suggests that at the population level, the benefits of deworming are likely to be modest and may not be warranted when weighing the prioritization of interventions to delay HIV progression in transmission in resource-limited settings.”
Judd Walson
The Helminth Eradication to delay ART Trial (HEAT) study was a non-blinded randomized trial that included 948 adults with HIV who were enrolled from Feb. 6, 2008, to June 21, 2011. The participants did not yet meet criteria for ART. They were randomly assigned to empiric albendazole (Albenza, CorePharma) treatment, given every 3 months, plus annual praziquantel (Biltricide, Bayer Pharma AG), or to the control group that received standard care. All of the participants had received prophylactic cotrimoxazole.
At baseline, there were no differences in CD4 counts and HIV RNA concentrations between the groups. In the treatment group, 238 participants reached a CD4 count of 350 cells/mm³, and in the control group, 262 participants reached a CD4 count of 350 cells/mm³. No significant differences were observed between the groups. Adverse events were similar between the groups, and in the treatment group, helminth infections were less prevalent in the final visit.
“Although this trial was large and done in an area with moderate helminth prevalence, the study might have been underpowered to detect a smaller treatment effect than we tested for,” Walson said. “Alternative approaches to delay HIV disease progression will be increasingly needed as access to ART and other services are scaled up in areas of the world with a high prevalence of HIV.”
Disclosure: Walson reports no relevant financial disclosures.
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