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Abstract：
Globally, schistosomes infect approximately 200 million people, with 90% of infections in sub-Saharan Africa. Schistosomiasis is hypothesized to increase HIV-1 acquisition risk, and multiple cross-sectional studies reported strong associations. We evaluated this hypothesis within four large prospective cohorts.
We conducted nested case-control analyses within three longitudinal cohorts of heterosexual HIV-1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow-up from 1993 to 2014. Cases HIV-1 seroconverted during prospective follow-up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment.
We included 245 HIV-1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV-1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV-1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species-specific effects, there was no statistically significant association between HIV-1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection.
Schistosomiasis was not a strong risk factor for HIV-1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV-1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV-1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.
We conducted nested case-control analyses within three longitudinal cohorts of heterosexual HIV-1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow-up from 1993 to 2014. Cases HIV-1 seroconverted during prospective follow-up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV-1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment.
We included 245 HIV-1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV-1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV-1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species-specific effects, there was no statistically significant association between HIV-1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection.
Schistosomiasis was not a strong risk factor for HIV-1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV-1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV-1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.
摘要：
全球范围内,血吸虫感染了大约2亿人，90%的感染发生在撒哈拉以南非洲。假设血吸虫病会增加HIV-1的获取风险，和多个横断面研究报告强关联。我们在四个大型前瞻性队列中评估了这一假设。
我们在来自肯尼亚和乌干达的三个异性HIV-1血清不一致夫妇和一个女性性工作者（FSW）队列的纵向队列中进行了嵌套病例对照分析。血清不一致夫妇研究在2004年至2012年之间进行，而FSW队列分析包括1993年至2014年的参与者随访。病例HIV-1在前瞻性随访期间血清转化;每个病例选择三个对照。存档血清中存在循环阳极抗原，在HIV-1血清转化之前收集，确定了患有活动性血吸虫病的参与者；免疫印迹确定了血吸虫物种。来自血清不一致夫妇队列的数据被汇总，而FSW队列是单独分析的，以允许适当的混淆调整。
我们包括来自血清不一致夫妇队列的245个HIV-1血清转化者和713个对照，以及来自FSW队列的330个HIV-1血清转化者和962个对照。血清不一致夫妇中活动性血吸虫病的患病率为20％，FSWs中为22％。在血清不一致的夫妇中，我们发现男性（校正比值比（aOR）=0.99，95％CI0.59至1.67）或女性（aOR=1.21，95％CI0.64至2.30）的血吸虫病与HIV-1获得风险之间没有关联。同样，在FSW队列中,我们检测到无相关性(校正发生率比(aIRR)=1.11,95%CI0.83~1.50).探索血吸虫物种特异性效应，HIV-1感染风险与曼氏血吸虫(血清不一致夫妇:aOR=0.90,95%CI0.56~1.44;FSW:aIRR=0.83,95%CI0.53~1.20)或血吸虫(血清不一致夫妇:aOR=1.06,95%CI0.46~2.40;FSW:IRa87,2.93,95%CI=1.87)之间无统计学显著关联.
在这四项前瞻性研究中，血吸虫病不是HIV-1感染的强危险因素。曼索尼是这些队列中大多数血吸虫病的原因，我们的结果不支持曼氏链球菌感染与HIV-1感染风险增加相关的假设.在FSW队列中，S.Hematomium感染与HIV-1风险升高的点估计相关，但没有统计学意义，血清不一致夫妇队列中没有正相关的趋势。
我们在来自肯尼亚和乌干达的三个异性HIV-1血清不一致夫妇和一个女性性工作者（FSW）队列的纵向队列中进行了嵌套病例对照分析。血清不一致夫妇研究在2004年至2012年之间进行，而FSW队列分析包括1993年至2014年的参与者随访。病例HIV-1在前瞻性随访期间血清转化;每个病例选择三个对照。存档血清中存在循环阳极抗原，在HIV-1血清转化之前收集，确定了患有活动性血吸虫病的参与者；免疫印迹确定了血吸虫物种。来自血清不一致夫妇队列的数据被汇总，而FSW队列是单独分析的，以允许适当的混淆调整。
我们包括来自血清不一致夫妇队列的245个HIV-1血清转化者和713个对照，以及来自FSW队列的330个HIV-1血清转化者和962个对照。血清不一致夫妇中活动性血吸虫病的患病率为20％，FSWs中为22％。在血清不一致的夫妇中，我们发现男性（校正比值比（aOR）=0.99，95％CI0.59至1.67）或女性（aOR=1.21，95％CI0.64至2.30）的血吸虫病与HIV-1获得风险之间没有关联。同样，在FSW队列中,我们检测到无相关性(校正发生率比(aIRR)=1.11,95%CI0.83~1.50).探索血吸虫物种特异性效应，HIV-1感染风险与曼氏血吸虫(血清不一致夫妇:aOR=0.90,95%CI0.56~1.44;FSW:aIRR=0.83,95%CI0.53~1.20)或血吸虫(血清不一致夫妇:aOR=1.06,95%CI0.46~2.40;FSW:IRa87,2.93,95%CI=1.87)之间无统计学显著关联.
在这四项前瞻性研究中，血吸虫病不是HIV-1感染的强危险因素。曼索尼是这些队列中大多数血吸虫病的原因，我们的结果不支持曼氏链球菌感染与HIV-1感染风险增加相关的假设.在FSW队列中，S.Hematomium感染与HIV-1风险升高的点估计相关，但没有统计学意义，血清不一致夫妇队列中没有正相关的趋势。
