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

• Main Authors: Kristin M Wall, William Kilembe, Bellington Vwalika, Cecile Dinh, Paul Livingston, Yeuk-Mui Lee, Shabir Lakhi, Debi Boeras, Htee Khu Naw, Ilene Brill, Elwyn Chomba, Tyronza Sharkey, Rachel Parker, Erin Shutes, Amanda Tichacek, W Evan Secor, Susan Allen
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2018-12-01
• Series: PLoS Neglected Tropical Diseases
• Online Access: https://doi.org/10.1371/journal.pntd.0006902
• ISSN: 1935-2727; 1935-2735

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.