Impact of Anthelmintic Therapy for Invasive Helminth Infection on Microbial Translocation, Inflammation, and Immune Response among Ugandans Living with HIV: A Randomized Proof of Concept Study

Microbial translocation drives chronic immune activation that is linked to HIV disease progression. Invasive parasitic gut nematodes induce microbial translocation and downregulate the expression of pro-inflammatory cytokines. We evaluated the impact of albendazole anthelmintic therapy on serum markers of microbial translocation and inflammation among helminth-infected Ugandans living with HIV. Participants were randomized to an immediate or delayed 400 mg of daily albendazole and followed for 1 month. Baseline stool analysis, conducted via multiparallel real-time quantitative polymerase chain reaction, determined the prevalence of parasitic infections. Baseline and follow-up blood draws evaluated soluble CD14 (sCD14), C-reactive protein (CRP), and 10 pro-inflammatory cytokines. Changes in biomarker concentrations over time and across randomization arms were evaluated using parametric and nonparametric tests. We enrolled 224 antiretroviral therapy-experienced Ugandan adults living with HIV. Twenty-four participants (10.7%) were infected with either Necator americanus or Strongyloides stercoralis (12 immediate arm; 12 delayed arm). At baseline, participants with current helminth infection had increased concentrations of CRP, interleukin (IL)-4, IL-6, IL-10, and tumor necrosis factor-α compared with uninfected participants. Among helminth-infected participants, those in the immediate therapy arm had nonsignificant higher mean sCD14 concentrations (1.40 µg/mL) at follow-up compared with participants in the delayed arm (95% CI: -0.17, 2.98; P = 0.06) with no significant differences observed in other biomarker concentrations. Increases in sCD14 following anthelmintic treatment in this cohort require further investigation in larger cohorts with longer follow-up durations. However, incorporating anthelmintic therapy into routine adult HIV care may provide subtle health benefits in this potentially vulnerable population.