Decrease in Seminal HIV-1 RNA Load After Praziquantel Treatment of Urogenital Schistosomiasis Coinfection in HIV-Positive Men—An Observational Study

BACKGROUND: Urogenital schistosomiasis due to Schistosoma hematobium infection is hypothesized to cause increased HIV-1 RNA shedding in semen in HIV co-infected men as result of chronic egg-induced inflammation in the prostate and the seminal vesicles. The effect of treatment with the antihelminthic agent praziquantel on seminal HIV-1 RNA load was assessed in this study. METHODS: HIV-1 RNA load was determined in blood plasma and semen at baseline and at 10-week follow-up. Praziquantel was administered at baseline and two weeks later. RESULTS: Eighteen HIV-positive men with S. haematobium co-infection were enrolled into the study. Status of antiretroviral therapy (ART): 6 ART-naïve and 12 ART-experienced. All participants became egg-negative in urine at follow-up. Among the ART-naïve men, the mean HIV-1 RNA load decreased by 0.32 log(10) copies per mL (4.41 vs 4.09) in blood plasma from baseline to follow-up, and in semen by 1.06 log(10) copies per mL (4.06 vs 3.00). CONCLUSIONS: This study demonstrated a decline in seminal HIV-1 RNA load following praziquantel treatment of urogenital schistosomiasis infection in HIV-positive men. The finding needs further exploration in a larger randomized study targeting praziquantel as a supplementary preventive measure of sexual transmission of HIV-1 in S. haematobium endemic areas in sub-Saharan Africa.