Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges

Abstract

After 30 years of the human immunodeficiency virus (HIV) epidemic, parasites have been one of the most common opportunistic infections (OIs) and one of the most frequent causes of morbidity and mortality associated with HIV-infected patients. Due to severe immunosuppression, enteric parasitic pathogens in general are emerging and are OIs capable of causing diarrhoeal disease associated with HIV. Of these, Cryptosporidium parvum and Isospora belli are the two most common intestinal protozoan parasites and pose a public health problem in acquired immunodeficiency syndrome (AIDS) patients. These are the only two enteric protozoan parasites that remain in the case definition of AIDS till today. Leismaniasis, strongyloidiasis and toxoplasmosis are the three main opportunistic causes of systemic involvements reported in HIV-infected patients. Of these, toxoplasmosis is the most important parasitic infection associated with the central nervous system. Due to its complexity in nature, toxoplasmosis is the only parasitic disease capable of not only causing focal but also disseminated forms and it has been included in AIDS-defining illnesses (ADI) ever since. With the introduction of highly active anti-retroviral therapy (HAART), cryptosporidiosis, leishmaniasis, schistosomiasis, strongyloidiasis, and toxoplasmosis are among parasitic diseases reported in association with immune reconstitution inflammatory syndrome (IRIS). This review addresses various aspects of parasitic infections in term of clinical, diagnostic and therapeutic challenges associated with HIV-infection.

Intestinal Parasitoses in HIV Infected Children in a Nigerian Tertiary Hospital

“…Most of the patients in the present study presented at the symptomatic and advanced clinical stages of HIV in which coinfections are common. Cryptosporidium has been previously noted to present with recurrent abdominal pains and cramps among HIV infected individuals [14,15]. This lends credence to the significant association between abdominal pain and intestinal cryptosporidium in the present study.…”

“…The high rates of cryptosporidial infection in the present study may probably be due to difficulties in isolating the aetiologic pathogen which is surmised to untowardly impact negatively on disease management. Cheap and effective drugs for the management of cryptosporidiosis are also scarce [14,15].…”

Prevalence of potentially zoonotic gastrointestinal parasites in canine faeces in Ibadan, Nigeria

“…Both parasites have been reported as agents of diarrheoa in HIV/AIDS infected persons. 45 Other GI parasites of public health concern like Cryptosporidium parvum, Giardia duodenalis, Taenia sp, Dipylidium caninum that were detected by previous studies 2,11 in dog faeces picked from the street were not found in the present study.…”

Hygiene practices for patients with HIV/AIDS

“…Among the opportunistic diseases transmitted by animals to people with HIV/AIDS, the most predominant in Brazil is toxoplasmosis, a cosmopolitan zoonosis caused by the protozoan Toxoplasma gondii. Transmission occurs primarily via the ingestion of oocysts present in the environment through fi nal hosts, cats, or intermediaries, men, other non-feline mammals and birds (22,(25)(26)(27)30) .…”