HIV-CNS Diseases and Parasitic Zoonoses in the Eastern Cape, South Africa

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DESCRIPTION (provided by applicant): This a re-revision of the proposal 1R21NS059321 first submitted to this program in 2006. In response to the requirements of the FOA, this project is intended to develop local research capacity in the Eastern Cape Province (ECP) of South Africa and to provide preliminary data in support of an R01 application to study the association of parasitic zoonotic infections and neurological complications with HIV infection and AIDS in the Eastern Cape Province (ECP) of South Africa. For the pilot project, we will focus on neurocysticercosis and cerebral toxocariasis as the parasitic zoonoses of interest. The specific aims of this project are to: 1) Strengthen and expand existing collaborations among investigators from the College of Public Health, University of Oklahoma Health Sciences Center in the USA, the Walter Sisulu University and the Nelson Mandela Academic Hospital in Mthatha, Eastern Cape, South Africa, the Division of Parasitic Diseases, National Center for Zoonotic, Vector-borne & Enteric Diseases at the Center for Disease Control and Prevention in the USA, Ross University in St-Kitts and the Cysticercosis Working Group in Eastern and Southern Africa (CWGESA), and through the conduct of the pilot study, provide additional training in epidemiologic research; 2) Conduct a pilot study to estimate the seroprevalence of toxocariasis and cysticercosis in six groups: patients with advanced HIV (stage 3), those who have non-advanced HIV infection (stages 1 and 2), and HIV negative patients, each group being further subdivided into those with and without clinically apparent neurological disorders; 3) Use these pilot study data to estimate the interaction between HIV and neurocysticercosis or neurological toxocariasis in the occurrence of neurological complications in adolescents and adults. The long-term goal of this project is to develop multidisciplinary-based interventions to more effectively control preventable parasitic zoonotic infections that may disproportionately affect people living with HIV/AIDS, contributing to neurological complications in this group. The initial phase of the project will consist of strengthening the existing collaborations among the investigators in the United States of America, South Africa and several countries of Eastern and Southern Africa (through the CWGESA), and evaluating the current state of knowledge in the region regarding the prevalences of parasitic zoonoses affecting the central nervous system in general, and neurocysticercosis and cerebral toxocariasis in particular, among people living with HIV/AIDS and in HIV-negative people in the Eastern Cape of South Africa. Training opportunities for students and colleagues will be identified during this phase. We will also work with the NMAH and the WSU to have their ethical board recognized by the Office for Human Research Protections (OHRP) of the United States Department of Health and Human Services (DHHS). We estimate that this phase will take between six and nine months to complete. In a second phase, a pilot study will be conducted to estimate seroprevalence and to measure the cross-sectional associations between neurological complications and prevalence of Taenia solium and Toxocara canis infections in persons with advanced HIV, with non-advanced HIV infection and those without HIV infection. PUBLIC HEALTH RELEVANCE: This project will identify processes that occur when people with HIV interact with parasites that both humans and animals can carry. The study will take place in the Eastern Cape Province in South Africa-where both HIV and parasitic infections are common. Learning more about the parasitic infection/HIV interaction could better prevent neurological disease in people with HIV.