Association Between CD4+ T-Lymphocyte Counts and Fecal Excretion of Schistosoma mansoni Eggs in Patients Coinfected with S. mansoni and Human Immunodeficiency Virus Before and After Initiation of Antiretroviral Therapy

Erick M. O. Muok Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Elses W. Simiyu Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Elizabeth A. Ochola Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Zipporah W. Ng'ang'a Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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W. Evan Secor Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Diana M. S. Karanja Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Pauline N. M. Mwinzi Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Zoology Department, Maseno University, Maseno, Kenya; Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya; Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia

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Previously, we have shown that persons with human immunodeficiency virus 1 (HIV-1) infection and reduced CD4+ T-lymphocyte counts excrete significantly fewer Schistosoma mansoni eggs than HIV-1–negative persons with similar intensities of schistosome infections. To determine how antiretroviral therapy (ART) might affect egg excretion, we conducted a study of HIV+ adults living in an area highly endemic for S. mansoni as they began an ART program. Fecal egg excretion and CD4+ T-lymphocyte counts were evaluated at enrollment as well as 2 and 4 weeks after initiation of ART. Fourteen individuals who were Kato–Katz-negative at enrollment subsequently started excreting S. mansoni eggs accompanied by a significant increase in CD4+ T lymphocytes (P = 0.004). Study participants who were S. mansoni egg-positive at enrollment and received both praziquantel and ART also showed significantly increased CD4+ T-lymphocyte counts compared with baseline (P < 0.0001). Our data support a role for CD4+ T lymphocytes in S. mansoni egg excretion.

Author Notes

* Address correspondence to W. Evan Secor, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333. E-mail: was4@cdc.gov

Financial support: This research was supported by an European and Developing Countries Clinical Trial Partnership Senior Fellowship awarded to P.N.M.M.

Authors' addresses: Erick M. O. Muok, Elizabeth A. Ochola, Diana M. S. Karanja, and Pauline N. M. Mwinzi, Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya, E-mails: EMuok@kemricdc.org, EAkinyi@kemricdc.org, DKaranja@kemricdc.org, and PMwinzi@kemricdc.org. Elses W. Simiyu, Zoology Department, Maseno University, Maseno, Kenya, E-mail: elsessim@yahoo.com. Zipporah W. Ng'ang'a, Department of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya, E-mail: zipnganga@gmail.com. W. Evan Secor, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, E-mail: was4@cdc.gov.

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