Open Access Highly Accessed Research article

The influence of different helminth infection phenotypes on immune responses against HIV in co-infected adults in South Africa

Zilungile L Mkhize-Kwitshana1*, Myra Taylor2, Pieter Jooste3, Musawenkosi LH Mabaso4 and Gerhard Walzl5

Author Affiliations

1 Offfice of the Deputy Dean: Postgraduate and Research, NRM School of Medicine, University of KwaZulu-Natal, P.O. Box 7, Congella, 4001, South Africa

2 Department of Public Health Medicine, University of KwaZulu-Natal, P.O. Box 7. Congella, 4001 South Africa

3 Nutritional Intervention Research Unit, P.O. Box 19070, Tygerberg, 7505, South Africa

4 HIV/AIDS, STI and TB, Human Sciences Research Council, Private Bag X07, Dalbridge, Durban 4014, South Africa

5 Department of Biomedical Sciences, University of Stellenbosch, Tygerberg, 7505, South Africa

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BMC Infectious Diseases 2011, 11:273  doi:10.1186/1471-2334-11-273

Published: 14 October 2011



The convergent distribution of the Human Immunodeficiency Virus (HIV) and helminth infections has led to the suggestion that infection with helminths exacerbates the HIV epidemic in developing countries. In South Africa, it is estimated that 57% of the population lives in poverty and carries the highest burden of both HIV and helmith infections, however, the disease interactions are under-researched.


We employed both coproscopy and Ascaris lumbricoides-specific serum IgE to increase diagnostic sensitivity and to distinguish between different helminth infection phenotypes and their effects on immune responses in HIV co-infected individuals. Coproscopy was done by formol ether and Kato Katz methods. HIV positive and negative adults were stratified according to the presence or absence of A. lumbricoides and/or Trichuris trichuria eggs with or without elevated Ascaris IgE. Lymphocyte subsets were phenotyped by flow cytometry. Viral loads, serum total IgE and eosinophils were also analysed. Lymphocyte activation markers (CCR5, HLA-DR, CD25, CD38 and CD71) were determined. Non parametric statistics were used to describe differences in the variables between the subgroups.


Helminth prevalence ranged between 40%-60%. Four distinct subgroups of were identified, and this included egg positive/high Ascaris-specific IgE (egg+IgEhi), egg positive/low IgE (egg+IgElo), egg negative/high IgE (egg-IgEhi) and egg negative/low IgE (egg-IgElo) individuals. The egg+IgEhi subgroup displayed lymphocytopenia, eosinophilia, (low CD4+ counts in HIV- group), high viral load (in HIV+ group), and an activated lymphocyte profile. High Ascaris IgE subgroups (egg+IgEhi and egg-IgEhi) had eosinophilia, highest viral loads, and lower CD4+ counts in the HIV- group). Egg excretion and low IgE (egg+IgElo) status demonstrated a modified Th2 immune profile with a relatively competent response to HIV.


People with both helminth egg excretion and high Ascaris-IgE levels had dysregulated immune cells, high viral loads with more immune activation. A modified Th2 helminth response in individuals with egg positive stools and low Ascaris IgE showed a better HIV related immune profile. Future research on helminth-HIV co-infection should include parasite-specific IgE measurements in addition to coproscopy to delineate the different response phenotypes. Helminth infection affects the immune response to HIV in some individuals with high IgE and egg excretion in stool.