A study of opportunistic parasitic infections and CD4 counts in HIV-seropositive individuals in Narketpally, South India

Abstract

Context: Human immunodeficiency virus (HIV), causative agent in AIDS, is fast becoming a major threat in the Indian subcontinent with an estimated 3.7 million persons being infected with HIV. The progressive decline in immunological and mucosal defensive mechanisms predisposes HIV-positive individuals to gastrointestinal infections, thus increasing susceptibility to a number of opportunistic intestinal pathogens, among which protozoan and coccidian parasites like Cryptosporidium Sp. , Isospora Sp. , Cyclospora Sp. are being frequently detected. Objectives: To determine the opportunistic parasitic infections of the gastrointestinal tract in HIV-seropositive individuals and simultaneously their TCD4+ counts in South India. Settings and Design: Individuals seropositive for HIV infection were selected, and a Performa including age, sex, marital status, history of exposure, present clinical condition along with socioeconomic status, hygiene, etc was collected. Statistical Analysis Used: Percentages, Mean, Standard deviation. Results: Cryptosporidium Sp and Isospora Sp were found in 17.8% and 17.1% of all samples, respectively. Entamoeba histolytica, Giardia lamblia, Entamoeba coli and Blastocystis hominis were seen in 15.6%, 12.6%, 10.4% and 4% of all examined feces, respectively. Among helminths, Hymenolepis nana, Ascaris lumbricoides , Ancylostoma duodenale , and Strongyloides stercoralis were found in 0.5%, 0.4%, 0.1%, and 0.03% of all patients, respectively. The TCD4+ counts in case of coccidian infections were 365 cells/mm 3 ± 86.43 whereas in case of other protozoan, helminthic and mixed parasitic infections they were: 468±40.50 cells/mm 3 , 429±190 cells/mm 3 and 312±65.74 cells/mm 3 respectively. Our data showed that among HIV-seropositive stool samples screened routinely, 44.6% were found positive for at least one parasitic agent. Concentration technique improved the findings to 59.5%. Among the intestinal parasites 88.4% infections were by protozoan parasites compared to 11% by helminthes. Of the protozoan parasitic infections Cryptosporidium Sp. , Isospora Sp., Entamoeba histolytica , Giardia lamblia were most frequently detected. Conclusions: Among intestinal parasites 88.4% infections were by protozoan parasites compared to 11% by helminthes. Of the protozoan parasitic infections Cryptosporidium Sp. , Isospora Sp. , Entamoeba histolytica, Giardia lamblia were detected in the majority of cases. Our findings also suggest that the intestinal parasitic infections vary with the geographical areas and studies must be carried out in respective regions to evaluate the frequent causes of intestinal parasitic infections in HIV-seropositive individuals. Early diagnosis of opportunistic infections and prompt treatment definitely contribute to increased life expectancy of infected individuals by delaying the progression to AIDS.