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Does Treating Worms In People With HIV Slow Progression To AIDS?
Of the 25 million people infected with HIV-1 in Africa, as many as half
are thought to be co-infected with worms (helminths), and there is
evidence
that these worms may result in a more rapid progression of HIV infection
to AIDS. Does treating these worms ("de-worming") slow down this
progression?
In a new study published in the open access journal PLoS Neglected
Tropical Diseases, Judd Walson and Grace John-Stewart at the University of
Washington, Seattle, USA set out to answer this question. Their study
found that there were simply not enough data to make any firm conclusions,
and
they call for larger, well-designed studies to help come to a definitive
answer.
In their study, the investigators did an exhaustive search (known as a
systematic review) to find every study ever conducted examining the link
between being infected with worms and the progression of HIV to AIDS. In
their final analysis, they included only those studies that met the
researchers' pre-specified quality criteria.
There were five studies in the final analysis. All five were limited by
short follow up times. Only one of these was a randomized controlled
trial
(RCT)-it compared the effects of treating worms in people with HIV against
no treatment. The trial did find some benefit from the de-worming
treatment. In patients with HIV who did not receive the de-worming
treatment, their viral load (a measure of the amount of HIV in their
bloodstream)
went up. In contrast, the viral load of patients who were de-wormed
remained stable. However, de-worming was not associated with improvements
in the
patients' immune status (as measured by the CD4 count) or in their
clinical condition.
The four other included studies, which were observational studies rather
than RCTs, also suggested that treating worms could have a beneficial
effect
as measured by a patient's viral load. But again these studies showed no
benefit in terms of a patient's immune status or clinical condition.
"After a comprehensive review of the available literature," say the
authors, "we conclude that there is not enough evidence to determine
whether
treating helminth infections in people with HIV is beneficial."
"There is a need for large randomized controlled trials with longer
follow-up duration in order to assess the impact of de-worming on HIV-1
progression in populations with a high prevalence of both helminth and
HIV-1 infection."
In a linked Expert Commentary entitled "Helminth-HIV Co-Infection: Should
We De-Worm?", Professor Zwi Bentwich (Ben Gurion University, Israel) and
colleagues, who were not involved in the study, examine the evidence that
helminth infections play a major role in the pathogenesis of HIV-1
infection
in Africa.
"Helminth infections have an ongoing prolonged and wide negative effect on
the health of the population, irrespective of their effects on HIV and
possibly other infections as well," say Bentwich and colleagues. "Thus,
control of helminths should be pursued in large parts of the developing
world
without delay and should not await the results of studies on the impact of
helminths on HIV or on other infections."
CITATION: Walson JL, John-Stewart G (2007) Treatment of Helminth
Co-Infection in Individuals with HIV-1: A Systematic Review of the
Literature. PLoS
Negl Trop Dis 1(3): e102. doi:10.1371/journal.pntd.0000102
Please click here
(link will go live on Wednesday, December 19, 2007)
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Are Tratarea Worms persoanelor cu HIV Slow progresie Pentru a SIDA? - Does Treating Worms In People With HIV Slow Progression To AIDS? - articole medicale engleza - startsanatate