The overall goal of this study is to determine if periodic de-worming of persons living with HIV in intestinal parasite-endemic regions will lead to decreased morbidity and mortality associated with HIV by reducing immune activation and intestinal damage associated with these diseases. The hypothesis for this project is that intestinal parasitic infections contribute to a modifiable pro-inflammatory state in persons living with HIV (PLWH). Aim 1: Determine the prevalence of intestinal parasitic infections in PLWH receiving care at an HIV-treatment center in Lilongwe, Malawi using a highly sensitive multi-parallel stool PCR test. Hypothesis: highly sensitive stool PCR testing will demonstrate that disease burden of parasitic infection in PLWH in Malawi is higher than historically reported based on stool microscopy. Aim 2: Determine the impact of parasitic infection on intestinal damage and immune activation by measuring sCD14, sCD163, and intestinal fatty acid binding protein (I-FABP) in PLWH. Hypothesis: plasma biomarkers reflecting intestinal damage and immune activation are elevated in those with HIV and parasitic co-infection compared with parasite-negative participants with HIV. Aim 3: Determine the impact of eradication of parasitic infection on intestinal damage and immune activation by measuring sCD14, sCD163, and intestinal fatty acid binding protein (I-FABP) in PLWH before and after treatment of parasitic co-infection. Hypothesis: plasma biomarkers reflecting intestinal damage and immune activation are elevated in those with HIV and parasitic co-infection, and these biomarkers decrease with anti-parasitic treatment.
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Number of Participants With and Without Intestinal Parasitic Infection
Timeframe: Baseline
Mean Soluble CD14 (sCD14) Levels
Timeframe: Baseline
Mean Soluble CD163 (sCD163) Levels
Timeframe: Baseline
Mean Intestinal Fatty-acid Binding Protein (I-FABP) Levels
Timeframe: Baseline
Percent Change of sCD14 Levels Pre- and Post-treatment
Timeframe: Baseline, 6 months after baseline visit
Percent Change of sCD163 Levels Pre- and Post-treatment
Timeframe: Baseline, 6 months after baseline visit
Percent Change of I-FABP Levels Pre- and Post-treatment
Timeframe: Baseline, 6 months after baseline visit