Decrease in Seminal HIV-1 RNA Load After Praziquantel Treatment of Urogenital Schistosomiasis Coinfection in HIV-Positive Men—An Observational Study

Abstract

BackgroundUrogenital schistosomiasis due to Schistosoma hematobium infection is hypothesized to cause increased HIV-1 RNA shedding in semen in HIV co-infected men as result of chronic egg-induced inflammation in the prostate and the seminal vesicles. The effect of treatment with the antihelminthic agent praziquantel on seminal HIV-1 RNA load was assessed in this study.MethodsHIV-1 RNA load was determined in blood plasma and semen at baseline and at 10-week follow-up. Praziquantel was administered at baseline and two weeks later.ResultsEighteen HIV-positive men with S. haematobium co-infection were enrolled into the study. Status of antiretroviral therapy (ART): 6 ART-naïve and 12 ART-experienced. All participants became egg-negative in urine at follow-up. Among the ART-naïve men, the mean HIV-1 RNA load decreased by 0.32 log10 copies per mL (4.41 vs 4.09) in blood plasma from baseline to follow-up, and in semen by 1.06 log10 copies per mL (4.06 vs 3.00).ConclusionsThis study demonstrated a decline in seminal HIV-1 RNA load following praziquantel treatment of urogenital schistosomiasis infection in HIV-positive men. The finding needs further exploration in a larger randomized study targeting praziquantel as a supplementary preventive measure of sexual transmission of HIV-1 in S. haematobium endemic areas in sub-Saharan Africa.

Case Report: Highlighting Male Genital Schistosomiasis (MGS) in Fishermen from the Southwestern Shoreline of Lake Malawi, Mangochi District

“…These cytokines can facilitate HIV replication, which can increase seminal viral shedding, alluding to a plausible additional risk of HIV transmission from males infected with HIV and urogenital schistosomiasis. [19][20][21] Examples such as Case 2 describing the coinfection of these two diseases could in future provide opportunities for further virological and immunological analyses to illustrate the impact of routine preventive PZQ treatment on the potential risk of HIV transmission among dually infected fishermen and other high-risk populations in endemic areas. Furthermore, additional diagnostic investigations to exclude other diseases such as STIs, which could be present in this case, would be informative.…”

Beyond the barrier: Female Genital Schistosomiasis as a potential risk factor for HIV-1 acquisition

“…Treatment of bacterial STI with antibiotics significantly decreases the concentration of HIV-1 RNA in seminal plasma ( Cohen et al., 1997 ). Similarly, African men with genital schistosomiasis showed a decline in the concentration of HIV-1 RNA in seminal plasma after treatment with praziquantel ( Midzi et al., 2017 ). Immunologically, egg-positive schistosome infection induces a strong Th2 bias ( Pearce et al., 1991 ).…”

Schistosoma and Other Relevant Helminth Infections in HIV-Positive Individuals—An Overview

“…Furthermore, leucocytospermia and high seminal levels of inflammatory cytokines as seen in men with urogenital schistosomiasis actually normalize after treatment of schistosomiasis with praziquantel [27]. A recent prospective clinical study assessed the effect of praziquantel treatment on HIV-1 RNA load in blood plasma and semen of HIV-infected men from Zimbabwe co-infected with urogenital schistosomiasis [28]. The study demonstrated a decline of seminal HIV-1 RNA load following praziquantel treatment.…”