SCHISTOSOMA MANSONI, NEMATODE INFECTIONS, AND PROGRESSION TO ACTIVE TUBERCULOSIS AMONG HIV-1–INFECTED UGANDANS

MICHAEL BROWN Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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GEORGE MIIRO Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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PETER NKURUNZIZA Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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CHRISTINE WATERA Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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MARIA A. QUIGLEY Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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DAVID W. DUNNE Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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JAMES A. G. WHITWORTH Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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ALISON M. ELLIOTT Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom; Medical Research Council Unit, Uganda Virus Research Institute, Entebbe, Uganda; Department of Pathology, University of Cambridge, United Kingdom; Wellcome Trust, London, United Kingdom

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Rates of tuberculosis (TB) in Africa are highest among people infected with HIV. Searching for additional risk factors in a cohort of HIV-infected Ugandan adults, we previously found that a type 2 cytokine bias and eosinophilia were associated with progression to active TB. A possible role for helminth infection was assessed in this study. We analyzed TB incidence in 462 members of this cohort who were screened for filarial infections, gastrointestinal nematodes, and schistosomiasis. Progression to TB was not associated with gastrointestinal nematodes (rate ratio [RR], 1.18; confidence intervals [CIs], 0.66–2.10) or Mansonella perstans (RR, 0.42; CI, 0.13–1.34). A weak association between Schistosoma mansoni infection and TB was found (RR, 1.42; CI, 0.86–2.34); after adjusting for potential explanatory variables and using more stringent diagnostic criteria, the association was strengthened (RR, 2.31; 1.00–5.33). This analysis suggests an effect of S. mansoni infection on progression to active TB among HIV-1–infected Ugandans.

Author Notes

Reprint requests: Michael Brown, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom. E-mail: michael.brown@lshtm.ac.uk.
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