Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy.

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections ("deworming") in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naïve individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART. Methodology/Principal Findings: To estimate the association between empiric deworming therapy and CD4 count after ART initiation, we performed a retrospective observational study among HIV-infected adults on ART at a publicly operated HIV clinic in southwestern Uganda. Subjects were assigned as having received deworming if prescribed an anti-helminthic agent between 7 and 90 days before a CD4 test. To estimate the association between deworming and CD4 count, we fit multivariable regression models and analyzed predictors of CD4 count, using a time-by-interaction term with receipt or non-receipt of deworming. From 1998 to 2009, 5,379 subjects on ART attended 21,933 clinic visits at which a CD4 count was measured. Subjects received deworming prior to 668 (3%) visits. Overall, deworming was not associated with a significant difference in CD4 count in either the first year on ART (β = 42.8; 95% CI, −2.1 to 87.7) or after the first year of ART (β = −9.9; 95% CI, −24.1 to 4.4). However, in a sub-analysis by gender, during the first year of ART deworming was associated with a significantly greater rise in CD4 count (β = 63.0; 95% CI, 6.0 to 120.1) in females. Conclusions/Significance: Empiric deworming of HIV-infected individuals on ART conferred no significant generalized benefit on subsequent CD4 count recovery. A significant association was observed exclusively in females and during the initial year on ART. Our findings are consistent with recent studies that failed to demonstrate an immunologic advantage to empirically deworming ART-naïve individuals, but suggest that certain sub-populations may benefit. Author Summary: It is estimated that up to half of all people infected with HIV in sub-Saharan Africa are co-infected with one or more gastrointestinal parasites. These parasitic infections may negatively impact the ability of the immune system to combat the HIV virus, leading to worse clinical outcomes in people with HIV. Therefore, routine, universal, empiric treatment of gastrointestinal parasite infections ("deworming") has been suggested as one strategy for optimizing HIV outcomes in this region. Previous studies have provided conflicting results on whether empiric deworming positively impacts markers of HIV disease progression such as CD4 count and viral load, but all of these studies were performed in HIV-infected individuals not yet on antiretroviral therapy. In this study, we measured the association between receipt of empiric deworming and CD4 count over time in HIV-infected adults taking antiretroviral therapy in southwestern Uganda, an area with a high parasite burden. We found that, overall, there was no significant association between deworming and change in CD4 count; however, when we performed a sub-analysis looking exclusively at females during the first year of ART, deworming was associated with significantly increased CD4 count. These results suggest that empiric deworming may not be an effective generalized strategy for improving HIV treatment outcomes in sub-Saharan Africa; however, the possibility of targeted benefit in specific sub-populations deserves further investigation. [ABSTRACT FROM AUTHOR]