• Inge Kroidl, Elmar Saathoff, Lucas Maganga, Williams H Makunde, Achim Hoerauf, Christof Geldmacher, Petra Clowes, Leonard Maboko, and Michael Hoelscher.
• Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich, Munich, Germany; National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania; German Center for Infection Research (DZIF), partner site Munich, Munich, Germany. Electronic address: ikroidl@lrz.uni-muenchen.de.
• Lancet. 2016 Oct 15; 388 (10054): 1912-1920.

BackgroundThe past decades have seen an ongoing controversial debate about whether the immune activation induced by helminths has an effect on the susceptibility of individuals to HIV. In view of this, we assessed the effect of lymphatic filariasis, a chronic helminth disease elicited by Wuchereria bancrofti, on HIV incidence in southwest Tanzania.MethodsIn this population-based cohort study, we enrolled a geographically stratified randomly chosen sample of about 10% of the households in nine distinct sites in southwest Tanzania. All household members present were followed up and tested for HIV and circulating filarial antigen, an indicator of W bancrofti adult worm burden. Our main outcome of interest was HIV incidence in participants with or without lymphatic filariasis.FindingsBetween May 29, 2006, and June 16, 2011, we enrolled 4283 households with roughly 18 000 participants. Of these, 2699 individuals from Kyela district participated in at least one round of the EMINI study. In the 1055 initially HIV-negative adolescents and adults with clearly defined lymphatic filariasis status, 32 new HIV infections were observed in 2626 person-years. HIV incidence in lymphatic filariasis-positive participants (1·91 cases per 100 person-years) was significantly higher than the incidence in lymphatic filariasis-negative participants (0·80 cases per 100 person-years). The age-adjusted and sex-adjusted incidence rate ratio was 2·17 (95% CI 1·08-4·37, p=0·0300). Lymphatic filariasis status remained an independent and significantly relevant risk factor for HIV infection when controlled for other known risk factors such as sexual behaviour and socioeconomic factors.InterpretationTo our knowledge, this is the first prospective study demonstrating a significantly increased risk of acquiring HIV for lymphatic filariasis-infected individuals. Immunological studies and interventional treatment studies that eliminate the adult worms and not only the microfilariae are needed to follow up on the results presented.FundingEuropean Union as part of EuropAid; German Federal Ministry of Education and Research; German Center for Infection Research.Copyright © 2016 Elsevier Ltd. All rights reserved.

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