Abstract
Intestinal parasitic infestations (IPI) are not uncommon in immunocompetent individuals. However, human immunodeficiency virus (HIV)-infected individuals with depleted immunity have an abnormally high susceptibility to infections. This study therefore, examines children with intestinal parasites according to HIV status and degree of immunosuppression. Consecutively consenting patients aged 1 to 15 years attending the Paediatric Clinic of acquired immune deficiency syndrome (AIDS) Prevention Initiative, Nigeria, were recruited as cases, while age and sex matched HIV negative controls were recruited from Out Patient Department of Jos University Teaching Hospital. Stool samples were examined for parasites by direct wet mount, formol-ether and modified Ziehl-Neelsen technique. Levels of immunosuppression were assessed amongst HIV-positive subjects. Five hundred and ten children aged 1 to 15 years equally divided between the two cohorts were enrolled for the study. Seventy-nine had IPI, giving a prevalence rate of 15.5%; 44 (8.6%) HIV positive and 35 (6.9%) HIV-negative children. The most prevalent extracellular parasite was Giardia lamblia, however HIV positives had significantly higher rate of G. lamblia infestation. Among the intracellular parasites, the infection rate in HIV-positive subjects (5.9%) was three times that in HIV-negative subjects (2.0%). HIV positive children with advanced and severe immunosuppression had significantly higher intracellular parasites. HIV status did not significantly predict the overall risk of having extracellular intestinal parasites however, it was noted that G. lamblia infection was significantly higher in HIV positive children. HIV positive children had higher risk of having intracellular parasites especially if they have advanced or severe immunosuppression. Therefore, the policy of screening children for intestinal parasites should continue irrespective of their HIV status. Those that are HIV positive children should specifically be screened for intracellular parasites. Key words: Intestinal parasites, HIV, Children, Prevalence, Immunosuppression.
Highlights
Intestinal parasitic infestations (IPI) are not uncommon in immunocompetent individuals
The overall prevalence rate (15.5%) of intestinal parasites in this study is lower than previous studies carried out on children from other parts of Nigeria (Holland et al, 1989; Enekwechi et al, 1994; Agi, 1995)
The lower prevalence rates in this study could be due to the fact that Jos is at a higher altitude and as such it has a lower environmental temperature compared to other parts of Nigeria
Summary
Intestinal parasitic infestations (IPI) are not uncommon in immunocompetent individuals. License 4.0 International License immunodeficiency virus (HIV)-infected individuals with depleted immunity has an abnormally high susceptibility to infections with even minimally pathogenic organisms (Garcia et al, 1997). About 40 million of people are infected with HIV/acquired immune deficiency syndrome (AIDS) including adults and children < 15 years, and out of this, about 2.5 million are children < 15 years. More than 90% of these infections are in subSaharan Africa. Nigeria accounts for 30% of the global burden of mother-to-child transmission (MTCT) of HIV and 10% of Paediatric HIV/AIDS. HIV accounts for 3% of deaths in under-5 years children in Nigeria and most of the deaths are from opportunistic infections
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