WHIS - Intestinal helminth infections and schistosomiasis and their relation to HIV-1 incidence, disease progression and immunology in Mbeya Region, Tanzania
MMRC: Petra Clowes (study coordinator), Mkunde Chachage (junior scientist, immunology laboratory), Lilli Podola (supervisor, immunology laboratory), Anthony Nsojo (helminth diagnostics, EMINI laboratory), Dickens Kowuor (data department) and Leonard Maboko (site principle investigator)
MUHAS: Zulfiqarali G. Premji (collaborator from Muhimbili College of Health and Allied Sciences)
LMU: Elmar Saathoff (principal investigator) and Christof Geldmacher (immunologist)
WHIS aims to examine the influence of helminth infections on the epidemiology and immunology of HIV infection. Specific objectives are
i. to assess the possible influence of different Helminth infections (Ascaris lumbricoides, Trichuris trichiura, Hookworm, Schistosoma haematobium and S. mansoni) on HIV prevalence, incidence and disease progression.
ii. to investigate whether and how different kinds of helminth infections change the human immune response to HIV, TB and other infectious diseases and to examine the possibility that helminth-infection increases the susceptibility of CD25 and CD4 T cells to infection with the Human Immunodeficiency Virus.
Furthermore WHIS includes a capacity building component that aims to provide PhD and MSc training to two young scientists from Tanzania.
The WHIS study is conducted within the framework of the EMINI survey, an EU funded project which was initiated in June 2006 and is still ongoing. To achieve the above objectives WHIS is made up of an epidemiology component (WHIS_Epi) that only uses data that are routinely being collected as per EMINI protocol and an immunology component (WHIS_Imu) that equally uses EMINI data but also requires collection of additional samples and data.
WHIS_Epi includes all ~17,000 EMINI participants. The third round of the EMINI survey (July 2008 to June 2009) included 50% of the participants for stool examinations and possible worm treatment, where the other 50% were planned to be examined for intestinal helminth infections one year later. Therefore, since July 2009 – the begin of the 4th survey round - all participants from both groups are examined and if necessary treated for intestinal worm infections. No additional visits to the study subjects are necessary for this part of WHIS; data collected during the annual EMINI visits will be used for the WHIS _Epi study. Subsequently, HIV incidence and disease progression over one year between groups can be compared.
WHIS_Imu includes a maximum of 480 participants from the EMINI cohort. Participants are chosen according to their present helminth infection and HIV status. 3 visits are planned for each participant where 40 ml of blood, a urine sample and a stool sample are being collected. Visits are conducted after identifying the participants through the EMINI survey (F0), six weeks later (F1) and one year later (F2). At F0 participants will receive, if indicated, worm treatment, F1 and 2 are therefore post treatment visits.
Viral load determination, CD4 counts and most of the immunology laboratory work is carried out at the well equipped NIMR-MMRC laboratory.
The study is still ongoing and no results regarding our main outcomes are available yet. An interim analysis is planned for early 2011.
The study is going well and participants for the WHIS_Imu part are steadily being recruited. It is difficult however to retain participants but every effort is made to explain the overall benefit of the study to the study subjects. There are not as many HIV-helminth co-infections in the EMINI study area as anticipated which might result in a smaller number of participants as originally planned.
WHIS is funded by the German Science Foundation (DFG) and also relies on data that are collected during the EC funded EMINI study.
The projected is a collaboration of the following institutions:
NIMR-Mbeya Medical Research Center in Mbeya, Tanzania.
The Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Germany
Muhimbili College of Health and Allied Sciences, Dar es Salaam, Tanzania.
First publications are expected in 2011.