AIDS-associated diarrhea and wasting in northeast Brazil is associated with subtherapeutic plasma levels of antiretroviral medications and with both bovine and human subtypes of Cryptosporidium parvum

Abstract

Advanced HIV infection is frequently complicated by diarrhea, disruption of bowel structure and function, and malnutrition. Resulting malabsorption of or pharmacokinetic changes in antiretroviral agents might lead to subtherapeutic drug dosing and treatment failure in individual patients, and could require dose adjustment and/or dietary supplements during periods of diarrheal illness. We determined the plasma levels of antiretroviral medications in patients that had already been started on medication by their physicians, in an urban infectious diseases hospital in northeast Brazil. We also obtained blood samples from patients hospitalized for diarrhea or AIDS-associated wasting, and we found reduced stavudine and didanosine levels in comparison with outpatients without diarrhea or wasting who had been treated at the same hospital clinic. There was a predominance of the protozoal pathogens Cryptosporidium and Isospora belli, typical opportunistic pathogens of AIDS-infected humans, in the stool samples of inpatients with diarrhea. We conclude that severe diarrhea and wasting in this population is associated with both protozoal pathogens and subtherapeutic levels of antiretroviral medications.

AIDS Diarrhea and Antiretroviral Drug Concentrations: A Matched-Pair Cohort Study in Port au Prince, Haiti

“…A previous study showing a correlation between AIDS diarrhea and low antiretroviral drug concentrations examined patients who presented with diarrhea after initiation of ART. 10 In this case, the occurrence of diarrhea during ART may have been an effect of poor adherence and treatment failure, rather than the cause. Other studies suggesting that AIDS diarrhea is in itself related to poor treatment outcome may not have controlled for HIV disease stage and severe immune suppression.…”

Especies de Cryptosporidum en pacientes inmunodeficientes e inmunocompetentes de Valparaíso: Estudio descriptivo

“…Cryptosporidium spp no se detectó en aquellos casos con diarrea cuyo recuento de CD4 fue igual o superior a 200 céls/mm 3 (Figura 1). En estos pacientes, la frecuencia de infección (7,5%) por este parásito, podría explicarse por un inadecuado nivel plasmático de los farmacos anti-retrovirales, como resultado de un aumento del metabolismo o excreción de los fármacos, debido a la distribución alterada dentro de los distintos compartimientos del cuerpo, o a una tardía concentración máxima en el plasma 25 ; también por la no adhesión de los pacientes a la terapia.…”

Multilocus Genotyping of Cryptosporidium Hominis Associated With Diarrhea Outbreak in a Day Care Unit in São Paulo

“…19,20,[22][23][24][25][26][27][28][29][30]32,33 Despite the number of reports indicating the association of this parasite with diarrhea in different settings and the presence of this parasite in the environment in different regions of this country, only 1 molecular assessment has been previously performed, in clinical samples collected in Fortaleza, Brazil. 47 We used previously described molecular tools 39,41,42 to analyze samples collected from children attending a day care at the Hospital das Clínicas, from March to May 2001, during which an outbreak of cryptosporidiosis took place. These tools allowed us to identify that the species associated with all 29 PCR-confirmed cases was C. hominis.…”