Intestinal parasitic infection in HIV- infected patients at different CD4 T-cell counts in an African rural and Peri-urban setting

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Background: Intestinal parasites especially coccidian parasites are related to gastrointestinal symptoms causing severe diarrhoea in HIV/AIDS patients. These parasitic infections have further complicated the problem of morbidity and mortality in HIV/AIDS patients especially in the sub Saharan Africa. Hence, this study investigated the occurrence of intestinal parasites in HIV/AIDS at different CD4 T-cell counts. Method: A cross sectional study was conducted on six hundred and seventy two (672) participants aged from 8 to 72 years of both sexes from April to July, 2011. Examination of stool by wet mount, formol-ether concentration including staining techniques; Field’s stain, Modified Field’s stain, and modified Ziehl Neelsen staining procedures were performed. Immunophenotyping was employed for CD4 T-cell counts determination. Results: The overall total prevalence of intestinal parasitic infections among the study participants was 19.3% with a significant difference (p<0.001) between HIV positive and negative participants giving a prevalence of 25.2% and 13.3% respectively. Coccidian parasites (Isospora belli (p<0.001), Cryptosporidium (p=0.032)) and the helminth Strongyloides stercoralis (p<0.001) infections were exclusive to HIV positive participants. The prevalence of Giardia lamblia was common among both study groups having prevalence of 11.4% and 11.8% in HIV positive and negative participants (p=0.905) respectively reaffirming the unopportunistic nature of the parasite. Infections with Cryptosporidium was common with participants in rural dwellings (p=0.039). I. belli (p<0.001), Cryptosporidium (p<0.05), Giardia lamblia (p<0.001) and Strongyloides stercoralis (p<0.05) were mostly found in diarrhoea stools. Isospora belli and Microsporidia infections were associated with CD4 T-cell count of 200 cells/µl and below. Diarrhoea was associated with participants with CD4 T-cell count of ≤50cells/µl. Conclusion: This finding showed that intestinal parasitic infections have a higher prevalence in HIV positive patients than HIV negative patients with coccidian parasites and S. stercoralis infections occurred exclusively in HIV positive patients. As HIV/AIDS disease coexists with intestinal parasitic infections in the sub-saharan region it is important to provide the necessary logistics required to diagnose important parasites to include PCR, Isoenzyme Analysis and Antigen detection which has proven to be a very effective means of diagnosing intestinal parasites.
A Thesis submitted to the Department of Clinical Microbiology, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the degree of Master of Philosophy, August-2012