Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2017 05 03() doi 10.1093/cid/cix416
Emerging evidence suggests that helminth infections are associated with lower insulin resistance (IR). Current deworming programmes might remove this helminth-associated protective effect. Therefore, we evaluated the anthelmintic treatment effect on changes in IR.
We conducted a double-blind household-cluster-randomized placebo-controlled clinical trial on Flores island, Indonesia, an area endemic for soil-transmitted helminths (STH). All subjects received four rounds of three-monthly albendazole or matching placebo for three consecutive days. The primary outcome was the change in homeostatic model assessment of IR (HOMA-IR) in those >16 years old. An intention-to-treat analysis was performed involving all subjects and ad hoc in the helminth-infected subjects.
We examined 797 (in 329 households) and 872 (in 353 households) subjects, who were assigned randomly into the albendazole and placebo arm, respectively. Albendazole was associated with a significant reduction in STH prevalence, total IgE and eosinophil count. Whereas albendazole had no effect on IR [Estimated treatment effect (95% CI), 0.006 (-0.010 – 0.022)], p=0.48] at the community level, it was associated with a significant increase in IR [0.031 (0.004 – 0.059), p=0.04, p-value for interaction=0.01] among helminth-infected subjects as detected by microscopy. Pathway analysis suggested that this might in part be due to an increased body mass index or a reduced eosinophil count.
Anthelmintic treatment reduces STH prevalence, total IgE and eosinophil count but has no effect on IR at the community level. In helminth-infected subjects, treatment significantly increases IR, highlighting the need for metabolic health monitoring with ongoing deworming programmes.