Nine hundred eighty-eight HIV-infected women receiving ART were examined at two visits during pregnancy and two postpartum visits. Women were treated with antimalarials when malaria-positive. Four hundred sixty-seven women were randomized to targeted treatment with albendazole (treated only when helminth stool screening was positive). Five hundred thirteen patients were randomized to non-targeted albendazole treatment (treatment at all time points regardless of results of helminth stool screening). Baseline prevalence of helminth infection was about 35% in both groups (Ascaris 21%, T. trichiura 7%, hookworm 6%).

Hemoglobin levels rose significantly from visit 1 to visit 2 in both groups and peaked at visit 3, then fell in both groups by visit 4. CD4 counts rose significantly in both treatment groups and appeared to be significantly higher at visit 4 in the non-targeted group. The prevalence of detectable HIV RNA dropped from 9% at visit 1 to 4.7% at visit 4 in the non-targeted group and from 9.4% to 3.6% in the targeted group.

COMMENTARY

Helminthic infections result in a large burden of disease in the developing world. Even in HIV-uninfected children and adults, the iron deficiency anemia resulting from helminth infection is responsible for significant morbidity. Antihelminthic therapy may be one of the most cost-effective interventions we have. This study is exciting in that it demonstrates that albendazole treatment of HIV-infected pregnant women is beneficial without the need for expensive microscopic screening for helminthic infection. In addition to reducing anemia, albendazole significantly positively impacted immunologic and virologic control of these women’s HIV disease. While the mechanism of this beneficial effect was not elucidated in these studies, it is likely that deworming positively affected mucosal integrity, reducing microbial translocation and may have reduced levels of elevated pro-inflammatory cytokines, which have been shown to up-regulate HIV replication. Further studies to elucidate the mechanisms responsible for the beneficial effect of albendazole would be of great interest.