Soil-transmitted helminth infections represent a large burden with over a quarter of the
world’s population at risk. Low cure rates are observed with standard of care (albendazole);
therefore, a more effective combination therapy (albendazole and ivermectin) is being
investigated but showed variable treatment efficacies without evidence of intrinsic parasite
resistance. Here, we analyzed the microbiome of Trichuris trichiura and hookworm-infected
patients and found an association of different enterotypes with treatment efficacy.
80 T. trichiura-infected patients with hookworm co-infections from Pak-Khan, Laos, received
either albendazole (n = 41) or albendazole and ivermectin combination therapy (n = 39).
Pre-/post-treatment stool samples were collected to monitor treatment efficacy and
microbial communities were profiled using 16S rRNA gene sequencing, qPCR, and shotgun
sequencing. We identified three bacterial enterotypes and show that pre-treatment enterotype is associated with efficacy of the combination treatment for both T. trichiura
(CRET1 = 5.8%; CRET2 = 16.6%; CRET3 = 68.8%) and hookworm (CRET1 = 31.3%; CRET2 =
16.6%; CRET3 = 78.6%). This study shows that pre-treatment enterotype enables predicting
treatment outcome of combination therapy for T. trichiura and hookworm infections.