Systemic strongyloidiasis complicating HIV: a promising response to ivermectin

Heath, Timothy C; Riminton, Sean; Garsia, Roger; Macleod, Colin

doi:10.1258/0956462961917843

Cited by 11 publications

(6 citation statements)

References 3 publications

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“…Only four cases were reported from the whole of Africa [43-46], three of which in South Africa, a state where adequate diagnostic facilities are available. We collected 83/244 (34%) reports from North America (USA [47-109] and Canada [110-116]), 58/244 (24%) from Europe (Belgium [40,117], France [118-129], Germany [130,131], Greece [132-134], Italy [135-141], the Netherlands [142-145], Spain [146-155], Switzerland [156], UK [157-164]) and five (2%) from Oceania (Australia [165-168] and New Zealand [169]). In these areas of low/no endemicity, half of the patients were immigrants (70/146, 48%), while a few subjects were veterans (5/146, 3%) who presumably acquired the infection during military service in an endemic country.…”

Section: Resultsmentioning

confidence: 99%

“…In a couple of organ transplant recipients, an ELISA test was negative pre-transplant, but resulted positive in the deceased donors (test performed retrospectively) [60,145]. In other two cases serology (ELISA) was negative: a HIV-infected person, who had larvae in stool and sputum [165] and a patient with dermatomyositis, under chronic treatment with prednisone and methotrexate, who died from disseminated strongyloidiasis (larvae found at autopsy in skin, lungs, small and large bowel, gall bladder, vessels of meninges and cervical spinal cord) [100]. …”

Section: Resultsmentioning

confidence: 99%

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Severe strongyloidiasis: a systematic review of case reports

et al. 2013

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BackgroundStrongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis.MethodsWe conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions.ResultsRecords screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%).ConclusionsProper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Severe strongyloidiasis: a systematic review of case reports

et al. 2013

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“…8,9 Because the number of cases is few, however, the effectiveness of ivermectin against strongyloidiasis in patients infected with HIV has not been fully studied. The disappearance of S. stercoralis and its symptoms after the administration of ivermectin in our patient may indicate that strongylodiasis is a curable disease, even in patients with AIDS, and at the same dose as for patients infected with S. stercoralis without HIV.…”

Section: Discussionmentioning

confidence: 99%

Strongyloidiasis in a patient with acquired immunodeficiency syndrome

Ohnishi

Kogure

Kaneko

et al. 2004

Journal of Infection and Chemotherapy

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“…Several studies have noted delays in HIV disease progression following deworming (Brown 2005; Ivan 2015; Lankowski 2014; Mulu 2013; Muok 2013; Wolday 2002 ), while others have reported no association (Brown 2004; Elliott 2003; Hosseinipour 2007; Kleppa 2014; Lawn 2000; Modjarrad 2005). In the previous version of this systematic review we found some evidence from randomized controlled trials of short term benefits with deworming but also the need for further larger studies (Walson 2009).…”

Section: Introductionmentioning

confidence: 99%

Antihelminthics in helminth-endemic areas: effects on HIV disease progression

Means

Burns

Sinclair

et al. 2016

Cochrane Database of Systematic Reviews

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BackgroundHelminth infections, such as soil-transmitted helminths, schistosomiasis, onchocerciasis, and lymphatic filariasis, are prevalent in many countries where human immunodeficiency virus (HIV) infection is also common. There is some evidence from observational studies that HIV and helminth co-infection may be associated with higher viral load and lower CD4+ cell counts. Treatment of helminth infections with antihelminthics (deworming drugs) may have benefits for people living with HIV beyond simply clearance of worm infections.This is an update of a Cochrane Review published in 2009 and we have expanded it to include outcomes of anaemia and adverse events.ObjectivesTo evaluate the effects of deworming drugs (antihelminthic therapy) on markers of HIV disease progression, anaemia, and adverse events in children and adults.Search methodsIn this review update, we searched online for published and unpublished studies in the Cochrane Library, MEDLINE, EMBASE, CENTRAL, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICRTP), ClinicalTrials.gov, and the WHO Global Health Library up to 29 September 2015. We also searched databases listing conference abstracts, scanned reference lists of articles, and contacted the authors of included studies.Selection criteriaWe searched for randomized controlled trials (RCTs) that compared antihelminthic drugs with placebo or no intervention in HIV-positive people.Data collection and analysisTwo review authors independently extracted data and assessed trials for eligibility and risk of bias. The primary outcomes were changes in HIV viral load and CD4+ cell count, and secondary outcomes were anaemia, iron deficiency, adverse events, and mortality events. We compared the effects of deworming using mean differences, risk ratios (RR), and 95% confidence intervals (CIs). We assessed the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Main resultsEight trials met the inclusion criteria of this review, enrolling a total of 1612 participants. Three trials evaluated the effect of providing antihelminthics to all adults with HIV without knowledge of their helminth infection status, and five trials evaluated the effects of providing deworming drugs to HIV-positive individuals with confirmed helminth infections. Seven trials were conducted in sub-Saharan Africa and one in Thailand.Antihelminthics for people with unknown helminth infection statusProviding antihelminthics (albendazole and praziquantel together or separately) to HIV-positive adults with unknown helminth infection status may have a small suppressive effect on mean viral load at six weeks but the 95% CI includes the possibility of no effect (difference in mean change −0.14 log10 viral RNA/mL, 95% CI −0.35 to 0.07, P = 0.19; one trial, 166 participants, low quality evidence).Repeated dosing with deworming drugs over two years (albendazole every three months plus annual praziquantel), probably has little or no effect on mean viral loa...

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Systemic strongyloidiasis complicating HIV: a promising response to ivermectin

Cited by 11 publications

References 3 publications

Severe strongyloidiasis: a systematic review of case reports

Severe strongyloidiasis: a systematic review of case reports

Strongyloidiasis in a patient with acquired immunodeficiency syndrome

Antihelminthics in helminth-endemic areas: effects on HIV disease progression

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