THE ASSOCIATIONS BETWEEN SCHISTOSOMIASIS INFECTION, PRESENCE OF GENITAL ABNORMALITIES, AND HIV PREVALENCE, TRANSMISSION, AND ACQUISITION IN LUSAKA, ZAMBIA Open Access

Dinh, Cecile (2011)

Permanent URL: https://etd.library.emory.edu/concern/etds/ks65hc94m?locale=en
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Abstract

Background: A reported 33.3 million people living in Sub-Saharan Africa are infected
with HIV. In Zambia, the estimated HIV prevalence ranges from 13.5% - 17%. An
estimated 20.7% of children in Zambia are infected with schistosomiasis, a parasitic
infection second only to malaria in prevalence, morbidity and mortality in Africa.
Individuals who are infected with schistosomiasis can develop symptoms that last a
lifetime. Symptoms of schistosomiasis include genital abnormalities, such as ulcers or
"sandy patches" that could increase the susceptibility or transmission of HIV.
Objective: This study examines the statistical associations between antibody to
schistosomiasis and HIV prevalence, acquisition and transmission, and the presence of
genital abnormalities.
Methods: 2168 individuals who were followed in the Zambia-Emory HIV Research
Project heterosexual cohort for at least three months were included in this study. Using
banked plasma and serum samples, enzyme-linked immunosorbent assays (ELISA) were
completed to detect schistosomiasis antibody titers. Clinical health data were obtained
from medical history and physical exams completed at ZEHRP enrollment visits.
Univariate logistic regressions were conducted to analyze the associations between
antibody titer to schistosomiasis; HIV prevalence, acquisition and transmission; and
genital abnormalities.
Results: Antibodies to schistosomiasis, overall, were not significantly associated with
being HIV-positive at baseline or transmitting HIV. Schistosomiasis infection was
significantly associated with the presence of some genital abnormalities, including
inguinal adenopathy, inflammation of the cervix in women, and gonorrhea.
Discussion: This study provides a snapshot of the possible complications that can
arise from being previously infected with schistosomiasis, in the context of the HIV
epidemic. Interestingly, it does not seem as if serologic evidence of past or present
schistosomiasis infection is a significant risk factor for transmission of HIV. Future
directions could take into account the timeline of events and whether an individual
acquires or transmits HIV due to the presence of genital abnormalities caused by
schistosomiasis, or if HIV exacerbates the effects of schistosomiasis. Furthermore,
ELISA results should be followed up with Western immunoblots to identify Schistosoma
mansoni
versus S. haematobium infection, and to confirm previous schistosomiasis
infection, particularly in individuals with intermediate titers.

Table of Contents



TABLE OF CONTENTS

INTRODUCTION AND BACKGROUND

HIV Prevalence 1

Schistosomiasis Prevalence 2

Symptoms of Schistosomiasis Infection 2

Genital Abnormalities 3

Rwanda-Zambia HIV Research Group 4

HIV and Schistosomiasis Co-Infection 5


METHODS

Study Design 7


Study Population 7


Schistosomiasis Testing 7


HIV Acquisition and Transmission 8


Genital Abnormality Variables 8


Logistic Regression Models 10


IRB Approval 11


RESULTS 12


DISCUSSION 15


STRENGTHS AND WEAKNESSES 17


FUTURE DIRECTIONS 19


REFERENCES 21


TABLES 25


APPENDICES 32

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