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Empiric Deworming to Delay HIV Disease Progression Does Not Work


Co-infection with HIV and helminth worms is common in sub-Saharan Africa, and findings from previous studies have suggested that anthelmintic treatment might delay immunosuppression in people with HIV. As a result, a study published in The Lancet Infectious Diseases (2012;12:925-932), was performed to assess the efficacy of empiric deworming of adults with HIV in in order to delay disease progression.


In this non-blinded randomized trial, adults 18 year of age or greater with HIV, who did not meet criteria for the initiation of antiretroviral treatment from three sites in Kenya, were enrolled in the study. Using a computer-generated sequence, eligible subjects were randomized to either empiric albendazole every 3 months plus praziquantel annually (anthelmintic treatment group), or to standard care (control group). Participants were followed up for 24 months. CD4 cell counts were measured every 6 months and plasma HIV RNA annually. The primary endpoints were a CD4 count of less than 350 cells per uL and a composite endpoint consisting of the first occurrence of a CD4 count of less than 350 cells per uL, first reported use of antiretroviral treatment, and non-traumatic deaths.


Between 6 February 2008, and 21 June 2011, the study enrolled and followed-up 948 participants; 469 were allocated to the treatment group and 479 to the control group. All participants were provided with the antimicrobial co-trimoxazole (a combination of trimethoprim and sulfamethoxazole) prophylaxis. Results showed that median baseline CD4 cell counts and HIV RNA concentrations did not differ between groups. No statistically significant difference was observed between the treatment and control groups in the number of people reaching a CD4 count of fewer than 350 cells per uL (41.6 events per 100 person-years vs. 46.2 events per 100 person-years; hazard ratio 0.89) or the composite endpoint (44.0 events per 100 person-years vs. 49.8 events per 100 person-years; 0.88). Serious adverse events, none of which thought to be treatment-related, occurred at a similar frequency in both groups.


According to the authors, the findings do not suggest an effect of empiric deworming in the delaying of HIV disease progression in adults with HIV in an area where helminth infection is common, and that alternative approaches are needed to delay HIV disease progression in areas where co-infections are common.


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