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Impact of quasi-elimination of Wuchereria bancrofti on HIV incidence in southwest Tanzania: A 12-year prospective cohort study.
Lancet HIV 12, e338-e345 (2025)
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DOI
PMC
BACKGROUND: Before introduction of anthelmintic treatment programmes in southwest Tanzania, our group described a 2·3-fold increase in HIV incidence among adults infected with the helminth Wuchereria bancrofti. Between 2007 and 2011, HIV incidence was 1·91 cases per 100 person-years in people with a W bancrofti infection and 0·80 cases per 100 person-years in those without the infection. We aimed to examine the impact of a reduction in W bancrofti infection as a result of mass drug administration on HIV incidence in southwest Tanzania. METHODS: The Risk of HIV Infections through Nematode Organism (RHINO) study is a prospective cohort study that used data from participants in one village collected during the Evaluation and Monitoring of the Impact of New Interventions (EMINI) study in 2007-11 and new data from EMINI participants collected in 2019. Study participants were tested for HIV and circulating filarial antigen (an indicator of W bancrofti infection), once a year from 2007 to 2011 and once in 2019. From 2009 to 2015, anthelmintics were annually distributed to all villagers through government programmes, followed by transmission assessment surveys. We analysed data from individuals aged 14-65 years with negative HIV test results at enrolment in EMINI in 2007. We did multilevel mixed-effects Poisson regression to describe and compare age-adjusted and sex-adjusted incidence rates. FINDINGS: Of the 1299 previous study participants rescreened in 2019, 1139 had been HIV-negative at the end of the last surveillance period in 2011 and were included in this analysis. 552 (48·5%) participants were female and 587 (51·5%) were male, and the median age was 26.4 years (IQR 19·8-37·8). Of the 1139 participants included, 848 (74·5%) never tested positive for W bancrofti infection, 272 (23·9%) previously tested positive but did not have a W bancrofti infection in 2019 (cured individuals), 15 (1·3%) tested positive for W bancrofti infection both in 2007-11 and 2019, and four (0·4%) had a new W bancrofti infection in 2019. Between 2011 and 2019, HIV incidence rate was 0·68 cases (95% CI 0·50-0·93) per 100 person-years in the 848 participants with no W bancrofti infection (39 new HIV infections during 5724 person-years) and 0·73 cases (0·45-1·17) per 100 person-years in the 272 cured individuals (17 new HIV cases during 2344 person-years; incidence rate ratio (IRR) after adjusting for age and sex 1·14, 95% CI 0·64-2·04; p=0·65). HIV incidence rate was 1·5 cases (0·39-6·04) per 100 person-years in the 15 individuals who tested positive for W bancrofti infection both in 2007-11 and in 2019 (two new HIV infection in 131 person-years; adjusted IRR 3·43, 95% CI 0·8-15; p=0·10). INTERPRETATION: In the group of participants cured of W bancrofti infection, the HIV incidence significantly decreased in 2011-19 compared with 2007-11, the period when they tested positive for W bancrofti infection. This effect was not observed in the group of individuals who never had a positive W bancrofti test, supporting the role of W bancrofti in HIV infection. FUNDING: The EU as part of EuropAid and Deutsche Forschungsgemeinschaft. TRANSLATION: For the Swahili translation of the abstract see Supplementary Materials section.
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Publikationstyp
Artikel: Journalartikel
Dokumenttyp
Wissenschaftlicher Artikel
ISSN (print) / ISBN
2352-3018
e-ISSN
2352-3018
Zeitschrift
The Lancet HIV
Quellenangaben
Band: 12,
Heft: 5,
Seiten: e338-e345
Verlag
Elsevier
Nichtpatentliteratur
Publikationen
Begutachtungsstatus
Peer reviewed
Institut(e)
Research Unit Global Health (UGH)