Schistosomiasis is associated with incident HIV transmission and death in Zambia.

• Main Authors: Kristin M Wall (Author), William Kilembe (Author), Bellington Vwalika (Author), Cecile Dinh (Author), Paul Livingston (Author), Yeuk-Mui Lee (Author), Shabir Lakhi (Author), Debi Boeras (Author), Htee Khu Naw (Author), Ilene Brill (Author), Elwyn Chomba (Author), Tyronza Sharkey (Author), Rachel Parker (Author), Erin Shutes (Author), Amanda Tichacek (Author), W Evan Secor (Author), Susan Allen (Author)
• Format: Book
• Published: Public Library of Science (PLoS), 2018-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1935-2727; 1935-2735; 10.1371/journal.pntd.0006902
• Keywords: Arctic medicine. Tropical medicine; RC955-962; Public aspects of medicine; RA1-1270
• Source: PLoS Neglected Tropical Diseases, Vol 12, Iss 12, p e0006902 (2018)

BACKGROUND:We examined relationships between schistosome infection, HIV transmission or acquisition, and all-cause death. METHODS:We retrospectively tested baseline sera from a heterosexual HIV-discordant couple cohort in Lusaka, Zambia with follow-up from 1994-2012 in a nested case-control design. Schistosome-specific antibody levels were measured by ELISA. Associations between baseline antibody response to schistosome antigens and incident HIV transmission, acquisition, and all-cause death stratified by gender and HIV status were assessed. In a subset of HIV- women and HIV+ men, we performed immunoblots to evaluate associations between Schistosoma haematobium or Schistosoma mansoni infection history and HIV incidence. RESULTS:Of 2,145 individuals, 59% had positive baseline schistosome-specific antibody responses. In HIV+ women and men, baseline schistosome-specific antibodies were associated with HIV transmission to partners (adjusted hazard ratio [aHR] = 1.8, p<0.005 and aHR = 1.4, p<0.05, respectively) and death in HIV+ women (aHR = 2.2, p<0.001). In 250 HIV- women, presence of S. haematobium-specific antibodies was associated with increased risk of HIV acquisition (aHR = 1.4, p<0.05). CONCLUSION:Schistosome infections were associated with increased transmission of HIV from both sexes, acquisition of HIV in women, and increased progression to death in HIV+ women. Establishing effective prevention and treatment strategies for schistosomiasis, including in urban adults, may reduce HIV incidence and death in HIV+ persons living in endemic areas.