High Prevalence of Diarrhoegenic Intestinal Parasite Infections among Non-ART HIV Patients in Fitche Hospital, Ethiopia

Abstract

BackgroundHIV infection has been modifying both the epidemiology and outcome of parasite infections. Hence, this study was undertaken to determine the prevalence of Cryptosporidium and other intestinal parasite infections among HIV positives with and without Antiretroviral Treatment(ART) and its association with CD4+ T-cell count.MethodsA cross-sectional study was conducted at Fitche hospital focusing on HIV positives who came to hospital for follow-ups. A total of 378 HIV positive persons with and without ART participated in the study. Data on socio-demographic factors and diarrhoea status were obtained by interviewing all 214 with ART and 164 without ART. Stool samples were collected from all patients and examined for intestinal parasites using direct, formol-ether and modified acid-fast staining techniques.ResultsThe prevalence of intestinal parasite infections in this study was significantly higher among HIV positive persons not on ART. Specifically, the rate of infection with Cryptosporidium species, Blastocystis spp., Giardia lamblia, and Entamoeba histolytica/E. dispar were higher, particularly in those with CD4+ T-cell counts less than 200 cells/µL. Fifty seven percent of the study participants were on ART. Out of these 164/378 (43%) of the non-ART study participants were infected with at least one intestinal parasite species. Significant association was observed between lower CD4+ T-cell count (<200 cells/µL) and the prevalence of Cryptosporidium spp. and Blastocystis spp. The two parasites were significantly more prevalent in HIV positive non-ART patients.ConclusionHIV infection increased the risk of having Cryptosporidium and other intestinal parasites and diarrhoea. Therefore, raising HIV positive’s immune status and screening for intestinal parasites is important. This study showed that patients who are taking ART had a lower prevalence of diarrhoea causing parasites and Cryptosporidium suggesting that ART through improvement of immune status of the patients may have contributed to controlling diarrhoea-causing parasites in HIV positive patients.

Prevalence and Risk Factors for Blastocystis Infection Among Children and Caregivers in a Child Care Center, Bangkok, Thailand

“…Some studies reported that the improved immune system could reduce Blastocystis infection among HIV-infected children who were on antiretroviral treatment when compared with those who did not receive the antiretroviral therapy. 27,28 In our study, the prevalence of Blastocystis infection among HIV-infected children was significantly lower than among those HIV negatives, which was consistent with other studies from China 29 and Tanzania. 30,31 There is no evidence that either antiretroviral drugs or co-trimoxazole can prevent Blastocystis infection.…”

Frequency of Intestinal Parasites in Patients With Gastrointestinal Disorders, in Different Parts of Iran During 2012-2013

“…It was estimated that 60% of people worldwide were infected with intestinal parasites (1,2). Recent estimates indicate that at least more than one-quarter of the world's population are infected with intestinal parasites and most of them are people who live in developing countries (2,3).…”

Emergent and re-emergent parasites in HIV-infected children: immunological and socio-environmental conditions that are involved in the transmission of Giardia spp. and Cryptosporidium spp.

“…Since the 1980s, waterborne protozoan parasites have emerged and re-emerged and became a worldwide public health problem, especially among vulnerable population groups (1) (2) . For example, children with a suppressed immune system are more susceptible to infections that are caused by opportunistic agents, especially when their CD4 + T-lymphocyte counts are <200 cells/mm 3 or 15%…”

“…Monitoring HIV-infected children who are undergoing continuous ART in specialized units can ensure that acute parasitic infections remain asymptomatic in these children (1) . Furthermore, continuous contact between these children and parasites and/or environmental exposure to asymptomatic parasite genotypes may cause asymptomatic infections (9) .…”

“…Furthermore, continuous contact between these children and parasites and/or environmental exposure to asymptomatic parasite genotypes may cause asymptomatic infections (9) . However, when the immunological system is suppressed or ART is discontinued, these patients' clinical conditions can deteriorate, and they can experience acute diarrhea and dehydration that requires hospitalization (1) .…”