Intervention Review

Deworming helminth co-infected individuals for delaying HIV disease progression

  1. Judd L Walson1,*,
  2. Bradley R Herrin2,
  3. Grace John-Stewart3

Editorial Group: Cochrane HIV/AIDS Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 19 JAN 2009

DOI: 10.1002/14651858.CD006419.pub3

How to Cite

Walson JL, Herrin BR, John-Stewart G. Deworming helminth co-infected individuals for delaying HIV disease progression. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD006419. DOI: 10.1002/14651858.CD006419.pub3.

Author Information

  1. 1

    University of Washington, Departments of Global Health, Medicine (Infectious Disease), and Pediatrics, Seattle, WA, USA

  2. 2

    University of Washington, School of Medicine, Seattle, Washington, USA

  3. 3

    University of Washington, Allergy and Infectious Diseases, Seattle, Washington, USA

*Judd L Walson, Departments of Global Health, Medicine (Infectious Disease), and Pediatrics, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA, 98104, USA. walson@u.washington.edu.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 8 JUL 2009

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The HIV-1 pandemic has disproportionately affected individuals in resource-constrained settings where other infectious diseases, such as helminth infections, also are highly prevalent. There are biologically plausible reasons for possible effects of helminth infection in HIV-1-infected individuals, and findings from multiple studies suggest that helminth infection may adversely affect HIV-1 progression. Since initial publication of this review (Walson 2007), additional data from randomized controlled trials (RCTs) has become available. We sought to evaluate all currently available evidence to determine if treatment of helminth infection in HIV-1 co-infected individuals impacts HIV-1 progression.

Objectives

To determine if treating helminth infection in individuals with HIV-1 can reduce the progression of HIV-1 as determined by changes in CD4 count, viral load, or clinical disease progression.

Search methods

In this 2008 update, we searched online for published and unpublished studies in The Cochrane Library, MEDLINE, EMBASE, CENTRAL, and AIDSEARCH. We also searched databases listing conference abstracts, scanned reference lists of articles, and contacted authors of included studies.

Selection criteria

We searched for RCTs and quasi-RCTs that compared HIV-1 progression as measured by changes in CD4 count, viral load, or clinical disease progression in HIV-1 infected individuals receiving anti-helminthic therapy.

Data collection and analysis

Data regarding changes in CD4 count, HIV-1 RNA levels, and/or clinical staging after treatment of helminth co-infection were extracted from identified studies.

Main results

Of 7,019 abstracts identified (6,384 from original searches plus 635 from updated searches), 17 abstracts were identified as meeting criteria for potential inclusion (15 from previous review plus an additional two RCTs). After restricting inclusion to RCTs, a total of three studies were eligible for inclusion in this updated review.

All three trials showed individual beneficial effects of helminth eradication on markers of HIV-1 disease progression (HIV-1 RNA and/or CD4 counts). When data from these trials were pooled, the analysis demonstrated significant benefit of deworming on both plasma HIV-1 RNA and CD4 counts.

Authors' conclusions

To date, three RCTs have evaluated the effects of deworming on markers of HIV-1 disease progression in helminth and HIV-1 co-infected individuals. All trials demonstrate benefit in attenuating or reducing plasma viral load and/or increasing CD4 counts. When taken together, there is evidence of benefit for deworming HIV-1 co-infected adults. Given that these studies evaluated different helminth species and different interventions, further trials are warranted to evaluate species-specific effects and to document long-term clinical outcomes following deworming.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Deworming helminth co-infected individuals for delaying HIV disease progression

Persons in resource-constrained settings are often disproportionately affected by both HIV-1 and other infectious diseases, such as helminth infections. Helminths are parasitic organisms that live within the human body. Over one-third of the world's population is infected with at least one species of helminth. Findings from some observational studies have suggested that treating helminth infections may slow the progression of HIV-1 disease. If treatment of helminth infections can reduce morbidity and mortality or delay the need for antiretroviral drugs among HIV-1-infected persons, the clinical, programmatic, and public health benefits of these effects are likely to be substantial. The results of this systematic review suggest that eradication of helminths appears to impart significant benefit to HIV-1 and helminth co-infected individuals. Further studies are warranted to determine the long-term impact of deworming and to evaluate the relative benefit of eradicating individual helminth species.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對於感染人類免疫缺陷病毒的病人同時有蠕蟲感染者,滅除蠕蟲可以延緩人類免疫缺陷病毒疾病的進行

第一型人類免疫缺乏病毒的大流行不成比例地影響到資源有限地區的人。這些地區通常其他感染症的盛行率也較高,像是蠕蟲感染。蠕蟲感染可能會影響到第一型人類免疫缺乏病毒感染的病人這似乎是有道理的,且從許多的研究顯示蠕蟲感染可能會對第一型人類免疫缺乏病毒感染的進展有不良影響。自從2007年一篇回顧性質的文章發表後,已有從隨機分配控制的臨床試驗的新資訊,我們從現有可取得的證據來評估第一型人類免疫缺乏病毒感染的病人治療蠕蟲感染是否可以影響第一型人類免疫缺乏病毒的進展。

目標

我們的目標是判斷對第一型人類免疫缺乏病毒感染的病人治療蠕蟲感染是否可以減緩第一型人類免疫缺乏病毒的進展,判定的依據包括CD4數目、病毒量、或臨床上疾病的進展(包含死亡率)。

搜尋策略

我們從網路上搜尋已發表和未發表的研究,包含The Cochrane Library (2006,期號3),MEDLINE (2006,11月),EMBASE (2006,11月),CENTRAL (2006,7月),AIDSEARCH (2006,8月)。我們也搜尋了包含會議報告摘要的資料庫,審視了文章的相關參考文獻,也連絡了參與其中研究的作者。

選擇標準

我們搜尋了隨機和半隨機分配的臨床試驗,這些試驗用CD4數目、病毒量、或臨床上疾病的進展來比較了第一型人類免疫缺乏病毒感染的病人接受了抗蠕蟲治療後疾病的進展。

資料收集與分析

經治療蠕蟲共同感染的病人其CD4數目、第一型人類免疫缺乏病毒量,臨床分期和/或死亡率的資料都來自這些選取的研究報告。

主要結論

在7019個選出的摘要中,17篇可能符合納入的條件,再加上限制條件後,共3篇是符合本回顧文章的條件。這3篇文章登顯示消除蠕蟲感染對於第一型人類免疫缺乏病毒感染可能有助益(病毒量及CD4淋巴球變化),這是和治療之前相比較或是與沒有感染蠕蟲的病人相比較或是與持續有蠕蟲感染的病人相比較。這些研究的追蹤期間從3到6個月。所有的資料統合後分析,消除蠕蟲感染對於第一型人類免疫缺乏病毒感染的病毒量及CD4淋巴球的變化有明顯的助益。

作者結論

至目前為止,有三個隨機分配臨床試驗探討清除蠕蟲感染在第一型人類免疫缺乏病毒感染者疾病進展的效果.它們都顯示清除蠕蟲感染可降低病毒量及升高CD4淋巴球。綜合三個研究,消除蠕蟲感染對於第一型人類免疫缺乏病毒感染的病人是有助益的。但這些試驗評估的是不同種的蠕蟲及不同的治療方式,未來的研究應針對治療特定的蠕蟲的效果及長期追蹤的效果。

翻譯人

本摘要由臺北榮民總醫院黃洸偉翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

在有限資源地區的人們常常不成比例地被第一型人類免疫缺乏病毒和其他傳染性疾病像是蠕蟲感染所影響。蠕蟲是一種生活在人體內的寄生蟲,全世界超過1/3的人口感染過至少一種蠕蟲。從一些觀察性研究的發現顯示治療蠕蟲感染可能會減緩第一型人類免疫缺乏病毒疾病的進展。如果治療蠕蟲感染可以減低死亡率和罹病率,或對於受到第一型人類免疫缺乏病毒感染的病人可以延緩需要抗反轉錄病毒藥物,則此類治療對於公共衛生的影響或許是有意義的。這個系統性回顧的結果顯示消除蠕蟲感染對於第一型人類免疫缺乏病毒感染的病人是有助益的。未來的研究應針對消除蠕蟲感染的長期追蹤效果及治療特定蠕蟲的相對療效.