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Background  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.    Methods  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.    Results  Helminth prevalence ranged between 40%-60%. Four distinct subgroups of were identified, and this included egg positive/high  Ascaris -specific IgE (egg + IgE hi ), egg positive/low IgE (egg + IgE lo ), egg negative/high IgE (egg - IgE hi ) and egg negative/low IgE (egg - IgE lo ) individuals. The egg + IgE hi  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 + IgE hi  and egg - IgE hi ) had eosinophilia, highest viral loads, and lower CD4 +  counts in the HIV -  group). Egg excretion and low IgE (egg + IgE lo ) status demonstrated a modified Th 2  immune profile with a relatively competent response to HIV.    Conclusions  People with both helminth egg excretion and high  Ascaris -IgE levels had dysregulated immune cells, high viral loads with more immune activation. A modified Th 2  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.

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