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PREVALENCE AND PREDICTORS OF INTESTINAL HELMINTH INFECTIONS AMONG HUMAN IMMUNODEFICIENCY VIRUS TYPE 1–INFECTED ADULTS IN AN URBAN AFRICAN SETTING

Sub-Saharan Africa is disproportionately burdened by intestinal helminth and human immunodeficiency virus (HIV)-1 infection. Recent evidence suggests detrimental immunologic effects from concomitant infection with the two pathogens. Few studies, however, have assessed the prevalence of and predictors for intestinal helminth infection among HIV-1–infected adults in urban African settings where HIV infection rates are highest. We collected and analyzed sociodemographic and parasitologic data from 297 HIV-1–infected adults (mean age = 31.1 years, 69% female) living in Lusaka, Zambia to assess the prevalence and associated predictors of helminth infection. We found at least one type of intestinal helminth in 24.9% of HIV-infected adults. Thirty-nine (52.7%) were infected with Ascaris lumbricoides, and 29 (39.2%) were infected with hookworm. More than 80% were light-intensity infections. A recent visit to a rural area, food shortage, and prior history of helminth infection were significant predictors of current helminth status. The high helminth prevalence and potential for adverse interactions between helminths and HIV suggests that helminth diagnosis and treatment should be part of routine HIV care.

Received November 6, 2004. Accepted for publication January 31, 2005.

Acknowledgments: We thank Kara Counseling, Dr. Susan Allen, Brad Fuller, and the staff of the Zambia–University of Alabama at Birmingham HIV Research Project for their assistance in recruiting participants for the study. We also thank Paddy Mukando, Joshua Kashitala, Joshua Siame, Alison Taylor, Patrick Chipaila, Francis Kasolo, Sandi Sianongo, and the rest of the clinical and laboratory staff of the Fogarty International Research Collaborative Award Project for their hard work and dedication to the study. We are most grateful to the participants of the study for their participation and cooperation.

Financial support: This work was supported by the National Institutes of Health (R03 TW05929), the University of Alabama at Birmingham Medical Scientist Training Program (T32 GM008361), the John J. Sparkman Center for International Public Health Education, the U.S. Department of Defense (National Security Education Program), the 1917 Clinic of the University of Alabama, Birmingham, the World Health Organization, GlaxoSmithKline, and Bayer.

^* Address correspondence to Kayvon Modjarrad, Department of Medicine, Division of Geographic Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, BBRB 206B, Birmingham, AL 35294-2170. E-mail: abraxas{at}uab.edu

Authors’ addresses: Kayvon Modjarrad, David O. Freedman, and Sten H. Vermund, Department of Medicine, Division of Geographic Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, BBRB 206B, Birmingham, AL 35294-2170, Telephone: 205-975-7700, Fax: 205-934-5600, E-mails: abraxas{at}uab.edu, freedman{at}uab.edu, and sten{at}uab.edu. Isaac Zulu and Lungowe Njobvu, Department of Medicine, University Teaching Hospital, Lusaka, Zambia, Telephone and Fax: 260-1-252-269, E-mails: zuluisaac{at}yahoo.com and lungowenjobvu{at}yahoo.com. David T. Redden, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35294-0022, Telephone: 205-934-4905, Fax: 205-975-2540, E-mail: samndave{at}uab.edu.

Reprint requests: Kayvon Modjarrad, Department of Medicine, Division of Geographic Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, BBRB 206B, Birmingham, AL 35294-2170.