A study of intestinal parasitic infections in HIV infected individuals in Puducherry

Introduction: Human immuno deficiency virus infection has become a pandemic. Infection with HIV results in a chronic illness characterized by a progressive decline in cell-mediated immune function. Diarrhoea occurs in almost 90% of patients with HIV in developing countries at sometime during the clinical course, and is the presenting symptom of approximately one third of patients with HIV infection. Aims: To find out the common enteric parasitic pathogens in the HIV infected individuals. To correlate the immune status to the parasitic infection. To find out the symptomatic correlation to the pathogens. Settings and Design: The cross sectional study was carried out in Puducherry for a period of 15 months. Materials and Methods: Two consecutive stool samples were collected from from HIV seropositive patients. The samples were concentrated and subjected to stool concentration, iodine and saline mounts & Kinyoun's staining. Statistical analysis used: Epi info 6 computer software package [CDC, Atlanta, Georgia, USA, 1995]. Results: Of the 22 diarrhoeic stools of HIV cases, 7(31.8%) yielded parasites on Kinyoun's staining; all 7(100%) were opportunistic protozoan pathogens. The prevalence of intestinal parasites among the HIV infected patients is as follows: Cryptosporidium sp. and Microsporidium sp., each were found in 6.3% of HIV seropositive cases. Strongyloides was seen in 2.5% of 80 seropositive cases. The mean CD4 counts in cases with parasites are listed as follows: Cryptosporidium sp.-133.2 cells, Microsporidium sp.-896 cells, Strongyloides stercoralis-228.5, Entamoeba histolytica/dispar-522 cells, Giardia sp. - 884 cells. Cryptosporidium sp. and Strongyloides stercoralis are found more in HIV seropositive cases with CD4 counts less than 200 cells; (p=0.002, OR=36, 95% CI=4-56) for Cryptosporidium sp. and ( OR=14.6, 95% CI=1.5-39.6) for Strongyloides stercoralis. There is a significant correlation between CD4 counts <200 p=0.005); OR=16.76(95%> Conclusions: The present study shows that Cryptosporidium is the predominant enteric protozoan parasite.