Should We Look for Strongyloides Stercoralis in Foreign-Born HIV-Infected Persons?

Abstract

The objective was to evaluate the implementation of a systematic Strongyloides stercoralis screening programme in HIV infected immigrants attending an HIV Unit in Spain. An enzyme-linked immunosorbent assay (ELISA) was performed to assess the presence of Strongyloides IgG. Patients with a positive serology were treated with ivermectin; serologic follow-up testing was performed. 237 patients were screened (65.4% men). Origin: 64.1% came from Latin America, 16.5% from Sub-Saharan Africa, 9.7% from the Caribbean, 9.7% from other areas. Strongyloides stercolaris IgG was positive in 13 cases (5.5%). In the multivariate analysis, factors associated with a positive Strongyloides serology were illiteracy (OR: 23.31; p=0.009) and eosinophilia (OR: 15.44; p<0.0001). Nine of the 13 patients positive for S. stercoralis IgG and treated with ivermectin had a follow up serologic test: 77.8% achieved a serologic response (55.5% seroreversion). Screening of HIV-positive immigrants may be desirable, at least in those with higher risk of hyperinfection syndrome. Serologic testing seems a useful tool in both diagnosis and follow-up of these patients.