Effects of malaria/helminthic coinfections on cervical cancer progression among sub Saharan African women on highly active antiretroviral therapy: A scoping review.

In Africa, the HIV prevalence in rural areas has begun to reach levels estimated within urban settings, where women are also more at risk for both malaria and intestinal parasitic infections. The objective of this review is to assess whether concomitant infections with malaria and/or helminthic diseases have an impact on cervical disease progression in women on HAART. This scoping review was conducted in August 2018. To conduct this scoping review, we searched the relevant studies in electronic databases such as PUBMED, Global Health, EMBASE, CINAHL and SCOPUS published in the year between 1960 and 2018 using the following search terms HAART AND malaria OR Helminth and Female OR women. Eight studies qualified for this review. The literature underscores the need for women on HAART with multiple co-infections to use adjuncts to retain immune recovery and undetectable HIV viral load, to reduce risk of cervical disease progression. A trend for higher risk of CIN3+ in HIV+ women reporting recent malarial infection was observed in one study. Given the public health impact of synergistic interactions between malaria and helminthic infections in HIV/HPV co-infected women on HAART, it is urgent that these interactions are elucidated.

Optimal control for HIV treatment.

Apart from the traditional role of preventing progression from HIV to AIDS, antiretroviral drug therapy (ART) has been shown to have the additional benefit of substantially reducing infectiousness in infected people, making ART potentially an important strategy in the fight against HIV. We developed a mathematical model based on the WHO's 5-stage classification of HIV/AIDS disease progression. Our model stratifies the population by disease stage, diagnosis and treatment. We used optimal control methods and data from South Africa to determine the best time-dependent treatment allocation required to minimize new infections, infection-years, deaths and cost. Our results indicated that the treatment strategy to minimize infection-years and new infections is to place emphasis on early treatment (i.e., treatment in Stage II & III), while to minimize cost and death, the emphasis should be on late treatment (i.e., Stage III & IV). Applying the optimal treatment strategy also leads to a substantial reduction in disease incidence and prevalence. The results of this study will hopefully provide some guidance for policymakers in determining how to best allocate antiretroviral drugs in order to maximize the benefits of treatment.