Study of opportunistic and other intestinal parasitic infections in relation to CD4 count among human immuno deficiency virus positive patients

Abstract

Background: Human Immunodeficiency Virus (HIV) infection is a significant health problem facing in Asia and Africa. Gastrointestinal infections are very common in patients with HIV infection or AIDS where diarrhea is a common clinical presentation caused by intestinal parasites. The main objective of this study was to establish the prevalence of intestinal parasitic infections among HIV positive people in Nepal. Methods & Materials: A total of 202 stool samples from HIV positive patients were examined by Formalin- ether sedimentation and Sheather-sucrose floatation followed by modified acid fast (Ziehl-Neelsen) staining techniques during the period of June to November 2015 at National public health laboratory (NPHL), Kathmandu. Results: Among 40 total infected patients, 33 (82.5%) were found to be infected with single parasite. Giardia lamblia was the most predominant one i.e. 9 (27.27%), followed by Entamoeba histolytica 6 (18.18%), Trichuris trichiura 5 (15.15%), hookworm 4 (12.12%), Ascaris lumbricoides 4 (12.12%), Cryptosporidium 3 (9.09%) and Cyclospora 2 (6.06%) respectively. Co-infection of hookworm and E. histolytica 2 (28.57%) and T. trichiura and A. lumbricoides 2 (28.57%) were the most predominant followed by G. lamblia and Cryptosporidium 1 (14.29%) and T. tichiura and E. histolytica 1 (14.29%). Co-infection with Cryptosporidium, hookworm and G. lamblia 1 (14.29%) was also observed. The prevalence of diarrhoea in infected cases was significantly higher (p < 0.05) than the non-infected cases. Significant difference existed in HIV patients with or without the use of Anti-Retroviral Therapy (ART) and in cases with or without the use of anti-parasitic drugs with p < 0.05 in both the cases. There was no significant difference between the occupation and the parasitic infection (p > 0.05) and between the CD4 count and the parasitic infection (p > 0.05). Conclusion: Opportunistic intestinal infection was observed only in AIDS patients (CD4 count < 200 cells/μl). The result indicates that parasitic infection in HIV patients are mainly due to illiteracy, poor hygiene and lack of access to the portable drinking water. Government and related health sector should take the preventive action for the control of HIV/AIDS and proper screening of intestinal parasitosis in HIV patients.