Opportunistic and Other Intestinal Parasites among HIV/AIDS Patients in Ethiopia

Endeshaw, Tekola (2005) Opportunistic and Other Intestinal Parasites among HIV/AIDS Patients in Ethiopia. PhD thesis, Addis Ababa University.

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Abstract

Rapid expansion of HIV/AIDS pandemic has brought about a dramatic change in the fauna of intestinal parasites worldwide. In HIV/AIDS patients, opportunistic intestinal parasites (OIP) are seriously causing hard- to-control diarrhoea in Africa. The well-known OIP that cause diarrhoea at latest stage of HIV infection are Cryptosporidium parvum, Isospora belli, Enterocytozoon bieneusi, Encephalitozoon intestinals and Cyclospora cayetenesis. The determination and recognition of these newly emerging parasites in immunocompetent, immunocompromised and HIV/AIDS patients was facilitated and increased with the advent of newly improved diagnostic methods. However, no detailed investigation of these parasites exists in Ethiopia. HIV/AIDS is also one of the major public health problems in Ethiopia severely affecting the productive and reproductive age groups of the society. The present study was aimed at investigating the relationship of OIP and HIV/AIDS in diarrhoea patients in Ethiopia . The assessment of the chemotherapeutic effect of intestinal parasites in the Wonji HIV/AIDS natural history study cohort showed that follow up visits of the cohort population based on scheduled regular visit diagnosis and treatment resulted in an impressive sustainable control of intestinal parasitic infections as compared to patients that visited Wonji hospital without such follow up. The Hospital setting was found more appropriate to study the relationship of intestinal parasites with emphasis on OIP in diarrhoeal patients with HIV/AIDS. After informed consent was obtained, 330 diarrhoeal patients were recruited. Clinical data and biological samples were collected. Blood was processed for HIV-testing by using ELISA and reactive samples were confirmed by western blot. CD4+cell count was done by FACScan, and viral load by NASBA. Stool was processed for parasites including ova, by direct and formol-ether method, Modified Ziehl Neelsen for Crypotosporidium, Isospora and Cyclospora, Autofluorecence for Cyclospora and Flurochrome Uvtitex-2B and nested PCR for intestinal microsporidia. Out of 330 diarrhoeal patients examined for intestinal parasites 268(81.2%) were positive for one or more parasites; and of these 74.2% were HIV positive. The major clinical presentations such as chronic diarrhoea lasted > 4weeks, severe weight loss>10%, and anorexia were more common in HIV positive than HIV negative patients. The common intestinal parasites such as Ascaris lumbricoides, Trichuris trichiura, Hookworm spp. and Schistosoma mansoni were very rare, and for each one of them the prevalence was below 2% in the HIV positives, and relatively high in the HIV negatives. Over all the nonopportunistic intestinal parasites such as A. lumbricoides, Taenia Spp. and E.histolytica/dispar were significantly higher in HIV negatives than HIV positives (P<0.001). Among the intestinal protozoan, Blastocystis hominis was frequently observed in HIV positive (36.3%) and HIV negative (31.8%) with no significant difference. The OIP were significantly higher in HIV positive diarrhoea patients: C. parvum 28.6%, I. belli 22.5% and intestinal microsporidia 18.2% (P<0.001). Except 6 cases (7.1%) of C. parvum no other OIP were detected in HIV negative patients. Based on PCR and microscopic analysis of the stool; microsporidia species involved as single and double infection of Enterocytozoon bieneusi and Encephalitozoon intestinalis were identified for the first time from HIV/AIDS patients in Ethiopia. The OIP were more frequently found with the CD4+ cell count below 50 cells/mm3 and except for a few cases of C. parvum and I. belli, the majority were found at CD4+ below 200 cells/mm3. Most of the OIP were found in association with high viral load (above 10000 copies/ml); Cryptosporidium 90%, Isospora 82.4% and intestinal microsporidia 89.3%. Most C. parvum and I. belli infected cases were detected from AIDS patients at stage IV while intestinal microsporidia were from both stage III and IV cases. From this study, it is suggested that early diagnosis of diarrhoeal patients for HIV and OIP is important to understand and management of diarrhoeal illness. This study also revealed that the majority of OIP were noted at CD4+ below 50 cells/mm3 and below 100cells/mm3 .Thus, it is advisable to initiate HAART (in this cases most likely at 200 cells/mm3) for HIV/AIDS patients in order to control the risk of developing diarrhoea disease by OIP.

Item Type:	Thesis (PhD)
Subjects:	H Social Sciences > HT Communities. Classes. Races R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Africana
Depositing User:	Tim Khabala
Date Deposited:	03 Sep 2018 14:29
Last Modified:	03 Sep 2018 14:29
URI:	http://thesisbank.jhia.ac.ke/id/eprint/8566

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