SUMMARYParasitic helminths are ubiquitous in most host, including human, populations. Helminths
often alter the likelihood of infection and disease progression of coinfecting
microparasitic pathogens (viruses, bacteria, protozoa), and there is great interest in
incorporating deworming into control programmes for many major diseases (e.g. HIV,
tuberculosis, malaria). However, such calls are controversial; studies show the
consequences of deworming for the severity and spread of pathogens to be highly variable.
Hence, the benefits of deworming, although clear for reducing the morbidity due to
helminth infection per se, are unclear regarding the outcome of
coinfections and comorbidities. I develop a theoretical framework to explore how helminth
coinfection with other pathogens affects host mortality and pathogen spread and evolution
under different interspecific parasite interactions. In all cases the outcomes of
coinfection are highly context-dependent, depending on the mechanism of helminth-pathogen
interaction and the quantitative level of helminth infection, with the effects of
deworming potentially switching from beneficial to detrimental depending on helminth
burden. Such context-dependency may explain some of the variation in the benefits of
deworming seen between studies, and highlights the need for obtaining a quantitative
understanding of parasite interactions across realistic helminth infection ranges.
However, despite this complexity, this framework reveals predictable patterns in the
effects of helminths that may aid the development of more effective, integrated management
strategies to combat pathogens in this coinfected world.