Empiric Therapy of Helminth co-Infection to Reduce HIV-1 Disease Progression - Full Text View

Purpose

Abstract:

Over 25 million HIV-1 infected individuals are currently living in Africa and as many as 50-90% may be co-infected with soil transmitted helminths such as roundworms, hookworms or whipworms. Helminth infection in HIV-1-infected individuals may increase HIV-1 RNA levels and increase the rate of progression of HIV-1 to AIDS. Studies have also shown that successful treatment of helminth co-infection (as documented by clearance of helminth eggs in stool) led to a significant decrease in HIV-1 plasma viral load (-0.36 log10). This change in viral load was significantly greater than that seen in those individuals without documented clearance of their helminth co-infection (+0.67 log10) (p=0.04). Studies conducted in Africa have shown an estimated 2.5-fold increased risk for sexual transmission of the HIV-1 for each log increase in plasma HIV-1 viral load. In addition to direct effects on plasma viral load, the rate of CD4 cell decline in helminth infected individuals may be directly impacted by the significant immune activation seen with such co-infection.

We propose a randomized controlled trial examining the potential benefits of routine empiric helminth eradication in HIV-1 infected adults who do not yet qualify for ARV therapy in Kenya. The current standard of care of symptomatic diagnosis and treatment will be compared to a systematic empiric scheduled de-worming program for HIV infected adults. We will compare markers of disease progression including rate of CD4 decline and changes in HIV-1 RNA levels between the two treatment arms.

Condition	Intervention
HIV Infections Helminthiasis	Drug: Albendazole Drug: Praziquantel Drug: Current standard of care in Kenya

MedlinePlus related topics:

AIDS

ChemIDplus related topics:

Albendazole Praziquantel

U.S. FDA Resources

Study Type:	Interventional
Study Design:	Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study

Official Title:	Empiric Therapy of Helminth co-Infection to Reduce HIV-1 Disease Progression

Further study details as provided by University of Washington:

Primary Outcome Measures:

CD4 count [ Time Frame: every 6 months for 24 months (enrollment and months 6, 12, 18 and 24 ) ] [ Designated as safety issue: Yes ]
HIV-1 RNA level [ Time Frame: enrolment, 12, and 24 months. ] [ Designated as safety issue: Yes ]

Secondary Outcome Measures:

Markers of clinical disease progression as measured by WHO staging criteria. [ Time Frame: Every 3 months for 24 months. (enrollment, months 3, 6, 9, 12, 15, 18, 21 and 24) ] [ Designated as safety issue: Yes ]

Estimated Enrollment:	850
Study Start Date:	February 2008
Estimated Study Completion Date:	October 2010
Estimated Primary Completion Date:	October 2010 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
1: Experimental Arm 1 will receive an intensive regimen of anti-helminthic therapy consisting of albendazole every three months for two years and praziquantel at enrollment and at one year of follow up.	Drug: Albendazole Every 3 months for 24 months (enrolment 3, 6, 9, 12, 15, 18, 21 and 24 months): 400mg/day X 3 days Drug: Praziquantel At enrolment and 12 months: 25mg/kg X 1
2: Active Comparator Arm 2 will receive symptomatic diagnosis and treatment of helminth infection as is current standard of care in Kenya.	Drug: Current standard of care in Kenya Current standard of care for HIV patients in Kenya based on WHO guidelines.

Show Detailed Description

Eligibility

Ages Eligible for Study:	18 Years and older
Genders Eligible for Study:	Both
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

Participants must not be or have been on highly active antiretroviral therapy.
Participants must have CD4 count >200 cells/mm3 in order to be enrolled in the randomized controlled trial.
Participants must be at least 18 years of age.
Participants must be able and willing to participate and give written informed consent.
Participants must be able and willing to return for the scheduled follow-up visits

Exclusion Criteria:

• Participants must not be pregnant at the time of enrollment (by urine HCG testing).

Contacts and Locations

Please refer to this study by its ClinicalTrials.gov identifier: NCT00507221

Contacts


Contact: Judd L Walson, MD, MPH	+254 72 1165696	walson@u.washington.edu

Locations


Kenya
	Kenya Medical Research Institute	Recruiting
	Nairobi, Kenya
	Contact: Ben Piper, MPH, MEM +254 72 9048847 benpiper@washington.edu
	Sub-Investigator: Phelgona Otieno, MBChB, MMed

Sponsors and Collaborators

University of Washington

Centers for Disease Control and Prevention

Kenya Medical Research Institute

Investigators


Principal Investigator:	Judd L Walson, MD, MPH	University of Washington

More Information

Publications:

Fincham JE, Markus MB, Adams VJ. Could control of soil-transmitted helminthic infection influence the HIV/AIDS pandemic. Acta Trop. 2003 May;86(2-3):315-33.

Bentwich Z, Weisman Z, Moroz C, Bar-Yehuda S, Kalinkovich A. Immune dysregulation in Ethiopian immigrants in Israel: relevance to helminth infections? Clin Exp Immunol. 1996 Feb;103(2):239-43.

Kassu A, Tsegaye A, Wolday D, Petros B, Aklilu M, Sanders EJ, Fontanet AL, Van Baarle D, Hamann D, De Wit TF. Role of incidental and/or cured intestinal parasitic infections on profile of CD4+ and CD8+ T cell subsets and activation status in HIV-1 infected and uninfected adult Ethiopians. Clin Exp Immunol. 2003 Apr;132(1):113-9.

Wolday D, Mayaan S, Mariam ZG, Berhe N, Seboxa T, Britton S, Galai N, Landay A, Bentwich Z. Treatment of intestinal worms is associated with decreased HIV plasma viral load. J Acquir Immune Defic Syndr. 2002 Sep 1;31(1):56-62.

Lawn SD, Karanja DM, Mwinzia P, Andove J, Colley DG, Folks TM, Secor WE. The effect of treatment of schistosomiasis on blood plasma HIV-1 RNA concentration in coinfected individuals. AIDS. 2000 Nov 10;14(16):2437-43.

Responsible Party:	University of Washington ( Judd L Walson, MD, MPH )
Study ID Numbers:	07-6824-B 01, KEMRI SSC #1251
First Received:	July 24, 2007
Last Updated:	February 13, 2008
ClinicalTrials.gov Identifier:	NCT00507221
Health Authority:	United States: Institutional Review Board; Kenya: Ministry of Health

Keywords provided by University of Washington:

HIV

Helminthiasis

Co-infection

Treatment Naive

Study placed in the following topic categories:

Albendazole

Virus Diseases

Sexually Transmitted Diseases, Viral

HIV Infections

Sexually Transmitted Diseases

Acquired Immunodeficiency Syndrome

Disease Progression

Praziquantel

Parasitic Diseases

Retroviridae Infections

Helminthiasis

Immunologic Deficiency Syndromes

Additional relevant MeSH terms:

Communicable Diseases

Anti-Infective Agents

Antiprotozoal Agents

RNA Virus Infections

Disease Attributes

Slow Virus Diseases

Molecular Mechanisms of Pharmacological Action

Immune System Diseases

Antineoplastic Agents

Antiplatyhelmintic Agents

Mitosis Modulators

Anthelmintics

Antimitotic Agents

Infection

Pharmacologic Actions

Anticestodal Agents

Antiparasitic Agents

Pathologic Processes

Therapeutic Uses

Tubulin Modulators

Lentivirus Infections

ClinicalTrials.gov processed this record on October 10, 2008

Sponsors and Collaborators:	University of Washington Centers for Disease Control and Prevention Kenya Medical Research Institute
Information provided by:	University of Washington
ClinicalTrials.gov Identifier:	NCT00507221