Associations between schistosome antibody status and incident HIV infection are not mediated by STIs / GUIs in a longitudinal cohort of Zambian men Open Access
Wang, Yuqing (Spring 2023)
Abstract
Introduction. Schistosomiasis is an acute and chronic parasitic disease caused by parasitic worms. Schistosoma haematobium and Schistosoma mansoni are two main species causing human infections in Zambia. Some articles indicate that the prevalence of schistosomiasis in Zambia may be associated with increased HIV infection risk. However, causal mechanisms between schistosomiasis and HIV infections need to be understood. Sexually transmitted infections (STIs), and other causes of genital ulceration and inflammation (GUI) may mediate observed associations between schistosomiasis infection and HIV risk. In this study, we conducted an analysis to evaluate whether the effect of Schistosome-specific (SH) antibody status on incident HIV acquisition or transmission is mediated by STIs / GUIs among men, who were recruited in a longitudinal cohort of heterosexual HIV serodiscordant couples in Zambia.
Methods. We retrospectively analyzed data from men in a Zambian HIV-discordant couple cohort. Data and samples were collected in Lusaka, Zambia between 1994-2012 in a nested case-control design. SH antibody status was tested at baseline by enzyme-linked immunosorbent assay (ELISA). Descriptive analyses and associations between SH antibody status and baseline covariates were assessed, stratified by baseline HIV antibody status. Associations between SH antibody and time varying STIs outcomes were assessed, stratified by HIV antibody status. Multivariable logistic regression and survival analysis were applied.
Results. Of 1046 men, 65.97% (N=690) had a positive SH antibody status at baseline. Among 599 HIV+ men, SH antibody status at baseline was associated with higher viral load (crude odds ratio [cOR]=1.12, 95%CI [1.01,1.23], p=0.03), and SH antibody positivity of partners (cOR=1.80, 95%CI [1.21, 2.69], p=0.004). Among 447 HIV- men, SH antibody status at baseline was associated with SH antibody status of their partner (cOR=2.00, 95% CI [1.30, 3.08], P=0.002). No significant associations were detected between SH antibody and time varying STI/GUI outcomes.
Discussion. The data from our cohort do not support the hypothesis that STIs /GUIs are mediators between SH antibody status and HIV infection risk. Potential biases due to sub-optimal diagnostic tools for STI status could affect the validity of our findings. Further studies are recommended to evaluate other mechanisms which explain the relationship among SH infections and HIV risk. This information could bolster the current strategy of HIV prevention in schistosomiasis endemic areas.
Table of Contents
Table of Contents
Chapter I: Literature Review 1
Schistosomiasis Epidemiology 1
Schistosomiasis and HIV 2
Mechanisms 3
Prevention and control 4
Technical and socioeconomic limitations 5
Summary 6
Chapter II: Manuscript 7
Abstract 7
Introduction 9
Methods 11
Results 14
Discussion 15
Conclusions 17
Chapter III: Public Health Recommendations 18
Tables and Figures 21
Reference 25
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Associations between schistosome antibody status and incident HIV infection are not mediated by STIs / GUIs in a longitudinal cohort of Zambian men () | 2023-04-17 10:32:07 -0400 |
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