Effect of high-intensity versus low-intensity praziquantel treatment on HIV disease progression in HIV and Schistosoma mansoni co-infected patients: a randomised controlled trial.
Effect of high-intensity versus low-intensity praziquantel treatment on HIV disease progression in HIV and Schistosoma mansoni co-infected patients: a randomised controlled trial.
复制标题
DOI：
10.12688/wellcomeopenres.14683.1
复制
发表时间：
2018-01-01
影响因子：
--
通讯作者：
Kamali, Anatoli
中科院分区：
文献类型：
--
作者：
Abaasa, Andrew;Asiki, Gershim;Kamali, Anatoli
背景：据推测，血吸虫合并感染加剧了HIV的进展，因此，对合并感染个体的虫媒干预将延缓HIV的进展。我们评估了高强度吡喹酮与低强度吡喹酮治疗血吸虫病对来自乌干达维多利亚湖周围渔业人群的合并感染患者的HIV疾病进展的影响。方法：2012年8月至2015年9月，我们进行了一项开放标签随机对照试验。未接受抗逆转录病毒治疗、CD4细胞计数≥350个/个、HIV和曼氏梭菌合并感染的成年人按1:1的比例随机分配到吡喹酮（40mg/kg）组，每季度（入组时开始）或每年（入组后12周开始）给予吡喹酮（40mg/kg），这样低强度参与者在12周时仍未接受治疗。招募了一个非随机的hiv阳性曼森氏阴性对照组。主要终点是12周和60周血浆病毒载量的平均变化。结果：共纳入受试者363人（高强度113人，低强度113人，对照组137人）；96例（85.0%）、97例（85.8%）和107例（78.1%）完成了60周的随访。调整基线年龄和病毒载量后，12周时高强度组与低强度组病毒载量的几何平均比（aGMR [95%CI]）为0.90 [0.65,1.25]p=0.55, 60周时为1.88 [0.78,4.53]p=0.16。对照组的结果与试验组相似。与低强度治疗相比，高强度治疗在所有随访中显著降低了曼氏链球菌的患病率
Background: It has been hypothesised that Schistosoma co-infection exacerbates HIV progression, and hence anthelminthic intervention in co-infected individuals will delay it. We evaluated effects of high-intensity versus low-intensity praziquantel treatment of schistosomiasis on HIV disease progression among co-infected patients from fishing populations around Lake Victoria, Uganda. Methods: Between August 2012 and September 2015, we conducted an open-label randomised, controlled trial. Adults, antiretroviral therapy-naive, CD4 counts ≥350 cells/mul, HIV and S. mansoni co-infected, were randomised 1:1 to praziquantel (40mg/kg) given quarterly (starting at enrolment) or annually (starting 12 weeks after enrolment; such that low-intensity participants were still untreated when sampled at 12 weeks). A non-randomised HIV-positive S. mansoni-negative comparison group was recruited. The primary outcome was mean change in plasma viral load at 12 and 60 weeks. Results: In total 363 participants (high-intensity 113, low-intensity 113, comparison group 137) were recruited; 96 (85.0%), 97 (85.8%) and 107 (78.1%) completed 60 weeks of follow up, respectively. Adjusting for baseline age and viral load, the geometric mean ratio (aGMR [95%CI]) viral load for high-intensity vs low-intensity groups at 12 weeks was 0.90 [0.65, 1.25] p=0.55 and at 60 weeks 1.88 [0.78, 4.53] p=0.16. Results in the comparison group were similar to trial arms. High-intensity, compared to low-intensity, treatment resulted in substantially lower S. mansoni prevalence at all follow up visits (p