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      Praziquantel efficacy against Schistosoma mansoni among HIV-1 infected and uninfected adults living in fishing villages along Lake Victoria, Northwest Tanzania

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          Abstract

          Background

          Animal studies have demonstrated that functional immune responses, as determined by the levels of CD4 + cell counts and anti-schistosome antibodies responses, determine the efficacy of praziquantel. Based on this evidence, it has been hypothesised that the immunodeficiency effects of the human immunodeficiency virus (HIV)-1 infection may affect the efficacy of praziquantel in co-infected human hosts. Thus, the present study assessed the efficacy of praziquantel by comparing parasitological cure rates and the reduction in infection intensity in HIV-1 seronegative individuals infected with S. mansoni and HIV-1 seropositive individuals co-infected with S. mansoni, following treatment with a single oral dose of praziquantel.

          Methods

          This was a prospective longitudinal study which included, at baseline, 555 S. mansoni infected adults aged 21–55 years, who were either co-infected or not with HIV-1 and who lived in fishing villages along Lake Victoria in Northwest Tanzania. These individuals were treated with a single oral dose of praziquantel (40 mg/kg) and, at 12 weeks, single stool samples were obtained and examined for S. mansoni eggs using the Kato-Katz technique. Finger prick and venous blood samples were collected for HIV-1 screening and CD4 + cell quantification.

          Results

          The parasitological cure rate did not differ significantly from the HIV-1 serostatus ( P = 0.12): among the co-infected individuals, the cure rate was 48.3% (14/29), and among the individuals infected only with S. mansoni, the cure rate was 62.6% (329/526). The egg reduction rate did not vary with the HIV-1 serostatus ( P = 0.22): 77.22% for HIV-1 seronegative and 75% for HIV-1 seropositive individuals. The level of CD4 + cell counts (median 228 cells/μL: range 202–380 cells) did not influence the cure rate ( P = 0.23) or the reduction in the intensity of the infection ( P = 0.37).

          Conclusion

          The HIV-1 infection per se or its moderate immunodeficiency effects, demonstrated by the range of CD4 + cell counts observed in co-infected individuals, did not affect praziquantel efficacy, as measured by the parasitological cure rate and the reduction in intensity of infection in the present study cohort.

          Electronic supplementary material

          The online version of this article (doi:10.1186/2049-9957-3-47) contains supplementary material, which is available to authorized users.

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          Most cited references34

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          Schistosoma mansoni: chemotherapy of infections of different ages.

          Mice were treated with potassium antimony tartrate, hycanthone, oxamniquine, niridazole, or praziquantel at different times after infection with Schistosoma mansoni. The rate of cure was assessed by perfusion of surviving worms approximately 4 weeks after treatment, and the percentage reduction in worm burden was estimated relative to the number of adult worms perfused from control mice, comparably infected but untreated. All six drugs were relatively inactive against S. mansoni between 3 and 4 weeks after infection when compared with treatment at 5 to 6 weeks. However, the drugs differed in the patterns of cure they achieved in the 2-week period after administration of cercariae and in the period around the onset of patency. Worms that had been subjected to amoscanate or hycanthone in the third week after infection showed evidence of this as adults in having a reduced fecundity. Factors such as worm or host physiology, or host immune status may have had roles in the outcome of chemotherapy at different stages of maturation of S. mansoni.
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            Drugs for the control of parasitic diseases: current status and development in schistosomiasis.

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              Praziquantel.

              Praziquantel is the drug of choice for the treatment of all forms of schistosomiasis. This review summarizes the main features of the drug, with special attention being given to those aspects that may be of interest to the practicing physician. After a brief mention of the history, the chemistry, the major available brands and their costs, doses and administration schedules are reviewed. Pharmacokinetics and drug interactions are analyzed and the low toxicity and mild side effects are stressed. A major weakness of praziquantel is its relative inefficacy against recent infections, a factor that may occasionally result in low cure rates in hyperendemic areas. Recent findings of schistosome isolates with a decreased sensitivity to praziquantel are discussed in the broader context of a possible emergence of drug resistance.
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                Author and article information

                Contributors
                humphreymazigo@gmail.com
                dwd10@cam.ac.uk
                kinunghi_csm@hotmail.com
                nuwahaf@yahoo.co.uk
                Journal
                Infect Dis Poverty
                Infect Dis Poverty
                Infectious Diseases of Poverty
                BioMed Central (London )
                2049-9957
                15 December 2014
                2014
                : 3
                : 1
                : 47
                Affiliations
                [ ]Department of Medical Parasitology and Entomology, School of Medicine, Catholic University of Health and Allied Sciences, P.O. Box 1464, Mwanza, Tanzania
                [ ]Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
                [ ]Department of Pathology, Division of Microbiology and Parasitology, Cambridge University, Tennis Court Road, Cambridge, CB2 1QP UK
                [ ]National Institute for Medical Research, Mwanza Research Centre, P.O. Box 1462, Mwanza, Tanzania
                Article
                87
                10.1186/2049-9957-3-47
                4322465
                25671125
                ad46dada-6063-4077-863f-cd56d861a0bc
                © Mazigo et al.; licensee BioMed Central. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 28 August 2014
                : 9 December 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                hiv-1,s. mansoni,co-infection,praziquantel,efficacy,tanzania
                hiv-1, s. mansoni, co-infection, praziquantel, efficacy, tanzania

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