Linking HIV with Neglected Tropical Diseases (NTDs)
Recently, there has been a lot of discussion about global health funding and how we can do more with less. As we reflect on 10 years of the President’s Emergency Plan for AIDS Release (PEPFAR), move forward with new funding streams for the Global Fund and transition bilateral and multilateral support to country-ownership platforms, we must examine the best ways to link HIV/AIDS services with other global health interventions. HIV/AIDS programs are often linked with other major global health challenges like tuberculosis, malaria, cervical cancer, and male circumcision.
But one integration approach that is not widely recognized but can have a far-reaching impact on HIV/AIDS treatment and prevention methods is for a little-known but widely pervasive group of parasitic and bacterial infections known as neglected tropical diseases (NTDs).
NTDs infect more than 1.4 billion people living in poverty around the world and disproportionately impact women and children. Geographically, areas of high NTD infection overlap with areas that have high prevalence rates of HIV/AIDS. Studies from the past twenty years have shown different ways that HIV/AIDS can be exacerbated by various NTD co-infections. NTDs weaken the immune system, making it more likely for an individual to contract other diseases and less likely that they will be able to fight them. Recent studies have shown that treatment for some NTDs is associated with decreased HIV viral loads and/or elevations in CD4 counts. Maternal soil-transmitted helminth infections, such as hookworm, roundworm, and whipworm, increase the risk of maternal-to-child HIV/AIDS transmission.
A parasitic infection known as schistosomiasis or snail fever is another major co-infection challenge that infects more than 200 million people, mostly in sub-Saharan Africa. It is transmitted by contact with contaminated fresh water, so swimming, bathing, fishing, and even domestic chores such as laundry and herding livestock can put people at risk of contracting the disease. But one form of the disease has particular repercussions for women and their health and reproductive systems. Known as female genital schistosomiasis (FGS), it causes pain and bleeding in the uterus, cervix and lower genital tract. These lesions provide conduits for the HIV virus to enter and infect women. Women with FGS have a 3-4 fold increase in the risk of acquiring HIV/AIDS. Not surprisingly, maps of the distribution of schistosomiasis and HIV/AIDS in Africa reveal extensive overlap in southern Africa, especially in Mozambique, South Africa, Tanzania, and Zimbabwe.
Integrated treatment campaigns for NTDs and HIV/AIDs need to begin now. It took almost 10 years for the AIDS community to accept the link between circumcision and HIV transmission and we don’t have that kind of time or resources to waste. By working together, the NTD and HIV/AIDS communities can enhance the impact of their programs, work more efficiently, and build better lives for at-risk communities around the world.
Dr. Neeraj Mistry is the managing director of the Global Network for Neglected Tropical Diseases, an initiative of the Sabin Vaccine Institute. Dr. Mistry was a founding member and former vice president of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria (GBC) where he led the work on co-investment and public-private partnerships with the President's Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund.