Intestinal parasitic infections among HIV/AIDS patients in relation to ART adherence in Nigeria

Abstract

Intestinal parasitic infections (IPI) cause morbidity among HIV-infected individuals. Poor adherence to antiretroviral therapy (ART) affects treatment outcomes, especially in low-middle-income countries. The study evaluated the prevalence of IPI among HIV patients in relation to ART adherence between May and November 2017. Ethical approval and consent were obtained from the ethical review committee of the Benue State Ministry of Health and patients respectively. Patients’ clinical records were reviewed, and ART adherence status was obtained from the adherence assessment cards. Participants were given two labelled sterile containers for stool samples. Direct wet mount of samples was prepared in normal saline to identify helminths ova and larvae. Samples were further processed using parasite concentrators. Slides were stained with Lugol’s iodine, modified Ziehl-Neelsen acid-fast and Giemsa and subsequently examined under a light microscope using x10 and x40 objectives. Data were analysed using the chi-square test and SPSS version 22. Of the 757 patients, females constituted 57.7% (n=437). Good adherence rate (>95%) was 61.9% (n=469). More females (n=301, 64.2%) than males (n=168, 35.8%) had good adherence status. IPI rate among ART patients was 16.4% (n=124). Entamoeba histolytica (n=5, 1.0%), Giardia lamblia (n=3, 0.6%) and Taenia sp. (n=8, 1.7%) were IPI seen among good adherence patients, and as single infections without diarrhoea. IPI was significant (p<0.05) among poor adherence patients (37.5%, n=108) compared to good adherence patients (3.4%, n=16). IPI were significant among females; 1.9% (n=9) in the good adherence group and 19.8% (n=57) in the poor adherence group. Cryptosporidium parvum (n=20, 6.9%), E. histolytica (n=15, 5.2%), E. coli (n=11, 3.8%), G. lamblia (n=10, 3.5%) and Taenia sp. (n=10, 3.5%) accounts for significant rates of infections among patients with poor adherence, with multiple infections and associated diarrhoea seen in 10 (3.5%) of them. Routine monitoring of HIV/AIDS patients for IPI by healthcare providers is necessary. Coinfected patients with poor ART adherence should be routinely screened for IPI and promptly treated. Antiparasitic drugs should be provided as prophylaxis along with ART, to enhance their overall treatment outcome.