Taryn A McLaughlin1, Azhar Nizam2, Felix Odhiambo Hayara3, Gregory Sadat Ouma3, Angela Campbell4, Jeremiah Khayumbi3, Joshua Ongalo3, Samuel Gurrion Ouma3, N Sarita Shah4,5, John D Altman1,6, Deepak Kaushal7, Jyothi Rengarajan1,8, Joel D Ernst9, Henry M Blumberg8, Lance A Waller2, Neel R Gandhi4,5,8, Cheryl L Day1,6, David Benkeser2. 1. Emory Vaccine Center, Emory University, Atlanta, GA. 2. Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA. 3. Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 5. Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA. 6. Department of Microbiology & Immunology, Emory University School of Medicine, Atlanta, GA. 7. Southwest National Primate Research Institute, Texas Biomedical Research Center, San Antonio, TX. 8. Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; and. 9. Division of Experimental Medicine, Department of Medicine, University of California, San Francisco, CA.
Abstract
BACKGROUND: Helminth infections can modulate immunity to Mycobacterium tuberculosis (Mtb). However, the effect of helminths, including Schistosoma mansoni (SM), on Mtb infection outcomes is less clear. Furthermore, HIV is a known risk factor for tuberculosis (TB) disease and has been implicated in SM pathogenesis. Therefore, it is important to evaluate whether HIV modifies the association between SM and Mtb infection. SETTING: HIV-infected and HIV-uninfected adults were enrolled in Kisumu County, Kenya, between 2014 and 2017 and categorized into 3 groups based on Mtb infection status: Mtb-uninfected healthy controls, latent TB infection (LTBI), and active TB disease. Participants were subsequently evaluated for infection with SM. METHODS: We used targeted minimum loss estimation and super learning to estimate a covariate-adjusted association between SM and Mtb infection outcomes, defined as the probability of being Mtb-uninfected healthy controls, LTBI, or TB. HIV status was evaluated as an effect modifier of this association. RESULTS: SM was not associated with differences in baseline demographic or clinical features of participants in this study, nor with additional parasitic infections. Covariate-adjusted analyses indicated that infection with SM was associated with a 4% higher estimated proportion of active TB cases in HIV-uninfected individuals and a 14% higher estimated proportion of active TB cases in HIV-infected individuals. There were no differences in estimated proportions of LTBI cases. CONCLUSIONS: We provide evidence that SM infection is associated with a higher probability of active TB disease, particularly in HIV-infected individuals.
BACKGROUND: Helminth infections can modulate immunity to Mycobacterium tuberculosis (Mtb). However, the effect of helminths, including Schistosoma mansoni (SM), on Mtb infection outcomes is less clear. Furthermore, HIV is a known risk factor for tuberculosis (TB) disease and has been implicated in SM pathogenesis. Therefore, it is important to evaluate whether HIV modifies the association between SM and Mtb infection. SETTING: HIV-infected and HIV-uninfected adults were enrolled in Kisumu County, Kenya, between 2014 and 2017 and categorized into 3 groups based on Mtb infection status: Mtb-uninfected healthy controls, latent TB infection (LTBI), and active TB disease. Participants were subsequently evaluated for infection with SM. METHODS: We used targeted minimum loss estimation and super learning to estimate a covariate-adjusted association between SM and Mtb infection outcomes, defined as the probability of being Mtb-uninfected healthy controls, LTBI, or TB. HIV status was evaluated as an effect modifier of this association. RESULTS: SM was not associated with differences in baseline demographic or clinical features of participants in this study, nor with additional parasitic infections. Covariate-adjusted analyses indicated that infection with SM was associated with a 4% higher estimated proportion of active TB cases in HIV-uninfected individuals and a 14% higher estimated proportion of active TB cases in HIV-infected individuals. There were no differences in estimated proportions of LTBI cases. CONCLUSIONS: We provide evidence that SM infection is associated with a higher probability of active TB disease, particularly in HIV-infected individuals.
Authors: Katarina Stete; Tracy R Glass; Govert J van Dam; Alex Ntamatungiro; Emilio Letang; Claudia J de Dood; Paul L A M Corstjens; Robert Ndege; Herry Mapesi; Winfried V Kern; Christoph Hatz; Maja Weisser; Jürg Utzinger; Matthias C Müller Journal: PLoS Negl Trop Dis Date: 2018-10-17