Intestinal parasites in Zambian patients with AIDS

Abstract

Previous studies have found a high prevalence of Isospora belli and Cryptosporidium parvum infections in African acquired immune deficiency syndrome (AIDS) patients with chronic diarrhoea. We aimed to determine the prevalence of gastrointestinal parasite in AIDS patients in hospital, not only those with diarrhoea, and to compare them with the general community. Clinically diagnosed AIDS patients in a Zambian teaching hospital were interviewed and examined, and stool specimens were studied for parasite infection. A control group was recruited from adults in a township near Lusaka. Of 90 AIDS patients (58% male), 50 (56%) had chronic diarrhoea and 9 (10%) had diarrhoea of shorter duration. In the control group (105 adults; 85% female), only one complained of diarrhoea. A variety of intestinal protozoa and helminths was found in 57% of AIDS patients and 88% of the community members. Isosporiasis was detected in 7, and cryptosporidiosis in 2, AIDS patients, all with diarrhoea, but not in any control. Strongyloides was found in 2 AIDS patients with diarrhoea and one community resident. Hospital patients with AIDS had fewer Entamoeba coli and E. histolytica infections, probably because of previous chemotherapy. We conclude that AIDS predisposes to isosporiasis and cryptosporidiosis, but not to infection with extracellular intestinal parasites, such as Entamoeba species, Blastocystis, Chilomastix, Endolimax, Ascaris and Necator.

Intestinal parasitic infection among the HIV-infected patients in Nepal

“…However, these studies were of smaller sample size. The prevalence of parasitic infections among HIV subjects ranged from 18.4% to 81.8% in different parts of the world [8,9,[16][17][18]. Such a huge difference in the prevalence of intestinal parasitic infection may be associated with the different levels of endemicity of such parasites.…”

“…Previous studies among people infected with HIV in many tropical and sub-tropical countries including Nepal have reported high prevalence of intestinal parasitic infection [4][5][6][7][8]. The inter-relationship of HIV and intestinal parasite infection is complex and yet to be fully understood.…”

“…The higher prevalence of intestinal parasitic infection in HIV-infected individuals has been reported to be associated with many factors including lower CD4 T-cell count, diarrhoea, living in a rural area, and poor nutrition [7,[9][10][11]. Some studies have reported that, in HIVinfected people, intestinal parasite prevalence is higher only in cases of opportunistic protozoal parasites, but not in the case of helminthes infestation [8,12]. Similarly, a high prevalence of intestinal parasites has been observed in HIV and TB co-infected patients [13].…”

Intestinal parasitic infections in human immunodeficiency virus (HIV)-positive and HIV-negative individuals in San Pedro Sula, Honduras.

“…In contrast, whereas the gut of HIV-infected individuals may not be a favorable environment for the establishment and or survival of extracellular parasites, intracellular and mucosal dwelling organisms may not be adversely affected by the pathologic changes. 18,21,23 The frequency of infection with C. parvum, S. stercoralis, and I. belli has been associated with increasing duodenal mucosa damage. 23 Unimpeded rates of intracellular parasite establishment and or survival may result in higher prevalence in HIV-infected individuals with enteropathy when compared with persons not infected with the virus.…”

“…[18][19][20][21] Virus-induced structural and functional impairment leading to common gastrointestinal symptoms has been shown to occur independently of infection with enteric pathogens. 22,23 This may selectively deter the establishment and or survival of extracellular and lumenal parasites. In contrast, whereas the gut of HIV-infected individuals may not be a favorable environment for the establishment and or survival of extracellular parasites, intracellular and mucosal dwelling organisms may not be adversely affected by the pathologic changes.…”