Increased hepatotoxicity among HIV-infected adults co-infected with Schistosoma mansoni in Tanzania: A cross-sectional study

Amon I. Marti, Soledad Colombe, Peter J. Masikini, Samuel E. Kalluvya, Luke R. Smart, Bahati M. Wajanga, Hyasinta Jaka, Robert N. Peck, Jennifer A. Downs

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Little is known about hepatotoxicity in patients with schistosome and HIV co-infections. Several studies have reported increased liver enzymes and bilirubin levels associated with schistosome infection. We investigated whether HIV-infected adults on antiretroviral therapy who had S. mansoni co-infection had a higher prevalence of hepatotoxicity than those without. METHODOLOGY/PRINCIPAL FINDINGS: We determined the presence and grade of hepatotoxicity among 305 HIV-infected outpatients who had been on medium-term (3-6 months) and long-term (textgreater36 months) antiretroviral therapy in a region of northwest Tanzania where S. mansoni is hyperendemic. We used the AIDS Clinical Trial Group definition to define mild to moderate hepatotoxicity as alanine aminotransferase, alanine aminotransferase, and/or bilirubin elevations of grade 1 or 2, and severe hepatotoxicity as any elevation of grade 3 or 4. We determined schistosome infection status using the serum circulating cathodic antigen rapid test and used logistic regression to determine factors associated with hepatotoxicity. The prevalence of mild-moderate and severe hepatotoxicity was 29.645/152) and 2.03/152) in patients on medium-term antiretroviral therapy and 19.630/153) and 3.35/153) in the patients on long-term antiretroviral therapy. S. mansoni infection was significantly associated with hepatotoxicity on univariable analysis and after controlling for other factors associated with hepatotoxicity including hepatitis B or C and anti-tuberculosis medication use (adjusted odds ratio = 3.0 [1.6-5.8], p = 0.001). CONCLUSIONS/SIGNIFICANCE: Our work demonstrates a strong association between S. mansoni infection and hepatotoxicity among HIV-infected patients on antiretroviral therapy. Our study highlights the importance of schistosome screening and treatment for patients starting antiretroviral therapy in schistosome-endemic settings. Additional studies to determine the effects of schistosome-HIV co-infections are warranted.
Original languageEnglish
JournalPLoS Neglected Tropical Diseases
Issue number8
Pages (from-to)e0005867
Publication statusPublished - 1-Aug-2017


  • Adult
  • Alanine Transaminase
  • Anti-Retroviral Agents
  • Bilirubin
  • Coinfection
  • Cross-Sectional Studies
  • HIV Infections
  • Humans
  • Liver Failure
  • Outpatients
  • Prevalence
  • Schistosomiasis mansoni
  • Tanzania


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