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Can Presumptive Anthelminthic Treatment Delay the Progression of HIV in ART-naïve Patients in Rural Africa?

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ClinicalTrials.gov Identifier: NCT00817713
Recruitment Status : Terminated (Terminated prematurely due to recruitment difficulties. Expansion to more study sites not planned.)
First Posted : January 6, 2009
Last Update Posted : February 16, 2011
Ifakara Health Research and Development Centre
University Hospital Inselspital, Berne
Merck KGaA
Information provided by:
Swiss Tropical & Public Health Institute

Brief Summary:

This study focuses on one of the major health issues of Sub-Saharan Africa: multi-parasitism and co-infections. In particular this study aims to elucidate the interaction of helminths with HIV.

There is good reason to suspect a detrimental effect of helminth infection on the course of HIV infection. We hypothesize, that treatment of helminths in HIV- and helminth co-infected individuals leads to a reduction of HIV viral load. With a lower HIV RNA level one would expect a slower decline of CD4 cells and hence also a slower progression of the disease. Ideally this would lead to a prolongation of the chronic phase of HIV infection and to a delay in the time when anti-retroviral treatment needs to be started.

Condition or disease Intervention/treatment
HIV Infections Helminthiasis Drug: Praziquantel, Ivermectin, Albendazole

Detailed Description:

* Background: On the basis of immunological considerations and in vitro trials on co-infections there is strong reason to suspect a detrimental effect of helminth infection on the course of HIV. The immunological answer very efficiently evoked by helminth infection is aimed at hijacking and suppressing the immune system in order to suit the requirements of the specific helminth. This permits helminths to cause chronic infection, often persisting over years and allowing some infecting worms to grow to several centimetres of length within their host. However, this immune modulation also affects non-related antigens (for example HIV) which would actually require a different line of immunological action.

Some clinical trials have been able to confirm this detrimental effect of helminths on HIV infection, while other trials failed to do so. A recent Cochrane review on clinical trials with HIV and helminth co-infection found an overall slight reduction of HIV viral load if helminth infection was treated. However there was no measurable effect on CD4 count or clinical staging of HIV. This might be explained by the fact that these trials were very heterogeneous in their set-up and were run for too short a time (max 6 months) to allow sufficient answers to these questions.

According to mathematical models, even a relatively modest reduction of HIV RNA by 0.5 log could delay the need to start combined antiretroviral therapy by about 3.5 years and potentially prolong the symptom-free phase of HIV-infection by nearly 1 year. On a population scale this could lead to substantial savings with regard to drug and clinical costs and on an individual level to an invaluable gain in drug-free and ideally also symptom-free life years.

  • Objective: To assess the impact of presumptive anthelminthic treatment on HIV progression in patients infected with HIV in a rural setting with presumed high prevalence of helminth infection.
  • Methods: Randomised open-label trial of presumptive triple anthelminthic treatment in HIV positive patients not yet requiring anti-retroviral treatment.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 295 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Can Anthelminthic Treatment Delay the Progression of HIV? Randomised Open-label Trial Testing Presumptive Anthelminthic Treatment on Progression of HIV in ART-naïve HIV-positive Patients in a Rural African Setting With Presumed High Prevalence of Helminth Infections.
Study Start Date : January 2009
Primary Completion Date : September 2010
Study Completion Date : September 2010

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS
U.S. FDA Resources

Arm Intervention/treatment
Active Comparator: anthelminthic treatment
Albendazol plus fix-dose Praziquantel plus Ivermectin
Drug: Praziquantel, Ivermectin, Albendazole

Standard HIV care plus triple anthelminthic treatment

  • Praziquantel 2400mg single dose
  • Ivermectin 12 mg, single dose
  • Albendazole 400mg, 2 doses in 1 day

All drugs given at baseline, after 6 months and after 12 months.

No Intervention: HIV care, no anthelminthic treatment
HIV care as per Tanzanian National AIDS Control Program (NACP) guidelines

Primary Outcome Measures :
  1. Difference in HIV viral load between intervention and control arm [ Time Frame: one year ]

Secondary Outcome Measures :
  1. Difference in CD4 counts between intervention and control arm [ Time Frame: one year ]
  2. Difference in time to meet criteria for the initiation of anti-retroviral treatment [ Time Frame: one year ]
  3. occurrence of severe adverse events [ Time Frame: one year ]

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • HIV-positive patients
  • most recent CD4-count > 250 c/μl (latest within the previous 7 months)
  • anti-retroviral treatment naïve
  • age >18 years
  • provide written informed consent

Exclusion Criteria:

  • Pregnant and lactating women in the first week of lactation
  • Symptoms of severe anemia (or haemoglobin <5g/dl within the precious 3 months)
  • Symptoms of chronic diarrhea (defined as >= 3 stools per day of loose consistency for more than 2 weeks)
  • Patients on treatment for tuberculosis
  • WHO clinical stage 3 disease and CD4-count <350 c/μl
  • WHO clinical stage 4 disease

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00817713

Chronic Disease Clinic of St. Francis Designated District Hospital
Ifakara, Kilombero, Tanzania, P.O. Box 53
Sponsors and Collaborators
Swiss Tropical & Public Health Institute
Ifakara Health Research and Development Centre
University Hospital Inselspital, Berne
Merck KGaA
Principal Investigator: Cornelia J. Staehelin, MD Swiss Tropical Institute, Ifakara Health Institute
Study Director: Christoph F. Hatz, MD, Prof. Swiss Tropical & Public Health Institute
Study Chair: Hansjakob Furrer, MD, Prof. Infectious Disease Unit, Inselspital, University Hospital Berne, 3010 Berne, Switzerland
Study Chair: Honorathy Urassa, MSc Ifakara Health Institute
Principal Investigator: Baraka Amuri, MD Ifakara Health Institute
Study Chair: Salim Hamis, MD Ifakara Health Institute
Study Chair: Juerg Utzinger, Prof. Swiss Tropical & Public Health Institute
Study Chair: Erik Mossdorf, MD Swiss Tropical & Public Health Institute


Responsible Party: Cornelia Staehelin, MD, Swiss Tropical Institute
ClinicalTrials.gov Identifier: NCT00817713     History of Changes
Other Study ID Numbers: 257/08
First Posted: January 6, 2009    Key Record Dates
Last Update Posted: February 16, 2011
Last Verified: April 2009

Keywords provided by Swiss Tropical & Public Health Institute:
Human Immunodeficiency Virus
treatment naive
immune modulation

Additional relevant MeSH terms:
HIV Infections
Disease Progression
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Disease Attributes
Pathologic Processes
Parasitic Diseases
Antiparasitic Agents
Anti-Infective Agents
Anticestodal Agents
Antiplatyhelmintic Agents
Antiprotozoal Agents
Tubulin Modulators
Antimitotic Agents
Mitosis Modulators
Molecular Mechanisms of Pharmacological Action
Antineoplastic Agents