Association between Taenia solium infection and HIV/AIDS in northern Tanzania: a matched cross sectional-study

Abstract

BackgroundThe frequency of Taenia solium, a zoonotic helminth, is increasing in many countries of sub-Saharan Africa, where the prevalence of the human immunodeficiency virus (HIV) is also high. However, little is known about how these two infections interact. The aim of this study was to compare the proportion of HIV positive (+) and negative (−) individuals who are infected with Taenia solium (TSOL) and who present with clinical and neurological manifestations of cysticercosis (CC).MethodsIn northern Tanzania, 170 HIV+ individuals and 170 HIV– controls matched for gender, age and village of origin were recruited. HIV staging and serological tests for TSOL antibodies (Ab) and antigen (Ag) were performed. Neurocysticercosis (NCC) was determined by computed tomography (CT) using standard diagnostic criteria. Neurological manifestations were confirmed by a standard neurological examination. In addition, demographic, clinical and neuroimaging data were collected. Further, CD4+ cell counts as well as information on highly active antiretroviral treatment (HAART) were noted.ResultsNo significant differences between HIV+ and HIV– individuals regarding the sero-prevalence of taeniosis-Ab (0.6% vs 1.2%), CC-Ab (2.4% vs 2.4%) and CC-Ag (0.6% vs 0.0%) were detected. A total of six NCC cases (3 HIV+ and 3 HIV–) were detected in the group of matched participants. Two individuals (1 HIV+ and 1 HIV–) presented with headaches as the main symptom for NCC, and four with asymptomatic NCC. Among the HIV+ group, TSOL was not associated with CD4+ cell counts, HAART duration or HIV stage.ConclusionsThis study found lower prevalence of taeniosis, CC and NCC than had been reported in the region to date. This low level of infection may have resulted in an inability to find cross-sectional associations between HIV status and TSOL infection or NCC. Larger sample sizes will be required in future studies conducted in that area to conclude if HIV influences the way NCC manifests itself.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-016-0209-7) contains supplementary material, which is available to authorized users.

Neurocysticercosis and HIV Infection: what can we learn from the published literature?

“…Information regarding control groups (i.e., HIVnegative individuals with NCC) is detailed in Table 1. A comparison was made using matched population 12 . The remaining control studies were included based on the following criteria: 1) Similar institutions where NCC/HIVpositive patients were evaluated 13 ; 2) pooled estimates of neurological symptoms associated with NCC obtained by a systematic review of the literature 14 ; and 3) series of patients from hospital settings in which radiological findings and outcomes were described 13,15,16,17,18,19,20,21,44 .…”

“…Two comparative studies allowed us to evaluate the effect of HIV on NCC prevalence, since it is possible that NCC represents an opportunistic infection. The first was a study where the prevalence of NCC (with CT-based diagnosis) in 170 matched HIV-positive and HIV-negative patients in northern Tanzania were evaluated and compared 12 . The authors did not find any significant differences in NCC prevalence and clinical manifestations between the two populations.…”

Disseminated cysticercosis and Kaposi sarcoma in a child with HIV/AIDS: A case report

“…Given the limited diagnostic capabilities, it is difficult to determine if the DC in this patient was a complication of primary infection with T. solium, or secondary to underlying immunodeficiency secondary to HIV/AIDS, chemotherapy, steroid administration, or reconstitution of the immune system following ART initiation. Infection with HIV has not been associated with increased prevalence of cysticercosis or increased severity of disease; however, prevalence of helminth infections seems to peak with a CD4 count of 200-500 [11,12,15].There is no clear association between HIV infection and cysticercosis [11,12], and it is difficult to determine if the subcutaneous nodules seen in our patient represent primary infection or unmasking of extant lesions following reconstitution of the immune system.…”

“…Disseminated cysticercosis is an uncommon manifestation of infection with T. solium and most commonly presents as subcutaneous and intramuscular nodules, although any organ can be infected [6][7][8][9][10]. Among people living with HIV, a recent case-control study did not find any association between HIV infection and NCC in Tanzania [11], and to date, no unique relationship between NCC and HIV has been reported [12]. We present a case of disseminated cysticercosis in a HIV positive child being treated for Kaposi sarcoma in Tanzania that presented as widespread subcutaneous lesions following initiation of antiretroviral therapy (ART) and chemotherapy.…”

Host immune responses during Taenia solium Neurocysticercosis infection and treatment

“…Like T. solium infection, HIV infection is also a leading cause of chronic immune activation in the CNS [72]. The prevalence of HIV in regions endemic for NCC is high [73]. Despite the presence of symptoms in NCC and HIV patients, little is known about the influence of HIV infection on the frequency, clinical course, and pathogenesis of NCC.…”