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Empiric deworming and CD4 count recovery in HIV-infected Ugandans initiating antiretroviral therapy.

Lankowski AJ, Tsai AC, Kanyesigye M, Bwana M, Haberer JE, Wenger M, Martin JN, Bangsberg DR, Hunt PW, Siedner MJ - PLoS Negl Trop Dis (2014)

Bottom Line: However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (β = 63.0; 95% CI, 6.0 to 120.1) in females.A significant association was observed exclusively in females and during the initial year on ART.Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naïve individuals, but suggest that certain sub-populations may benefit.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America; Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

ABSTRACT

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections ("deworming") in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naïve individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.

Methodology/principal findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or non-receipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (β = 42.8; 95% CI, -2.1 to 87.7) or after the first year of ART (β =  -9.9; 95% CI, -24.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (β = 63.0; 95% CI, 6.0 to 120.1) in females.

Conclusions/significance: Empiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naïve individuals, but suggest that certain sub-populations may benefit.

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Related in: MedlinePlus

Predicted CD4 count by time on ART.Predicted values are based on the multivariable linear regression model y = α+β1t+β2t+β3t+β4t, where the independent variable, y, is CD4 count; the dependent variable, t, is time on ART, the y-intercept, α, is CD4 count at t = 0, and β1–β4 are respective β-coefficients for the co-variables age, TB co-infection, deworming, and deworming*time interaction.
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pntd-0003036-g001: Predicted CD4 count by time on ART.Predicted values are based on the multivariable linear regression model y = α+β1t+β2t+β3t+β4t, where the independent variable, y, is CD4 count; the dependent variable, t, is time on ART, the y-intercept, α, is CD4 count at t = 0, and β1–β4 are respective β-coefficients for the co-variables age, TB co-infection, deworming, and deworming*time interaction.

Mentions: In our primary multivariable linear regression analysis (Table 2), deworming was not significantly associated with a change in CD4 count over time in either the first year on ART (β = 42.8; 95% CI, −2.1 to 87.7) or after the first year of ART (β = −9.9; 95% CI, −24.1 to 4.4). In this model, statistically significant predictors of CD4 count were age, time on ART, tuberculosis co-infection, and receipt of deworming. Based on estimates derived from our primary model, predicted CD4 count as a function of time on ART is graphically depicted in Figure 1. In our sensitivity analyses, excluding outlier CD4 values, extending the treatment window, or adjusting for additional socio-demographic variables did not yield qualitatively different results.


Empiric deworming and CD4 count recovery in HIV-infected Ugandans initiating antiretroviral therapy.

Lankowski AJ, Tsai AC, Kanyesigye M, Bwana M, Haberer JE, Wenger M, Martin JN, Bangsberg DR, Hunt PW, Siedner MJ - PLoS Negl Trop Dis (2014)

Predicted CD4 count by time on ART.Predicted values are based on the multivariable linear regression model y = α+β1t+β2t+β3t+β4t, where the independent variable, y, is CD4 count; the dependent variable, t, is time on ART, the y-intercept, α, is CD4 count at t = 0, and β1–β4 are respective β-coefficients for the co-variables age, TB co-infection, deworming, and deworming*time interaction.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4125278&req=5

pntd-0003036-g001: Predicted CD4 count by time on ART.Predicted values are based on the multivariable linear regression model y = α+β1t+β2t+β3t+β4t, where the independent variable, y, is CD4 count; the dependent variable, t, is time on ART, the y-intercept, α, is CD4 count at t = 0, and β1–β4 are respective β-coefficients for the co-variables age, TB co-infection, deworming, and deworming*time interaction.
Mentions: In our primary multivariable linear regression analysis (Table 2), deworming was not significantly associated with a change in CD4 count over time in either the first year on ART (β = 42.8; 95% CI, −2.1 to 87.7) or after the first year of ART (β = −9.9; 95% CI, −24.1 to 4.4). In this model, statistically significant predictors of CD4 count were age, time on ART, tuberculosis co-infection, and receipt of deworming. Based on estimates derived from our primary model, predicted CD4 count as a function of time on ART is graphically depicted in Figure 1. In our sensitivity analyses, excluding outlier CD4 values, extending the treatment window, or adjusting for additional socio-demographic variables did not yield qualitatively different results.

Bottom Line: However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (β = 63.0; 95% CI, 6.0 to 120.1) in females.A significant association was observed exclusively in females and during the initial year on ART.Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naïve individuals, but suggest that certain sub-populations may benefit.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America; Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America.

ABSTRACT

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections ("deworming") in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naïve individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.

Methodology/principal findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or non-receipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (β = 42.8; 95% CI, -2.1 to 87.7) or after the first year of ART (β =  -9.9; 95% CI, -24.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (β = 63.0; 95% CI, 6.0 to 120.1) in females.

Conclusions/significance: Empiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naïve individuals, but suggest that certain sub-populations may benefit.

Show MeSH
Related in: MedlinePlus