Intestinal Parasitoses and CD4 Levels among HIV/AIDS Patients Attending a Health Facility in Akpabuyo, Nigeria

Abstract

Many HIV/AIDS patients still present with low CD4 count and other complications even when placed on highly active antiretroviral therapy (HAART). Prevalence of intestinal parasitoses and their influence on CD4 levels of HIV/AIDS patients attending a Hospital in Nigeria was studied to determine their role in low CD4 levels during treatment. Two hundred and fifty HIV sero-positive and 100 sero-negative subjects were recruited for the study. HIV screening was done using Determine and confirmed with Unigold with Start Park as tie breaker. Questionnaires were used to obtain subject’s bio-data, Partec Cyflow counter (GEM Laboratories, Germany) was used for estimation and differentiation of CD4 cells while parasites were detected using direct stool microscopy, formal ether and modified Ziehl Neelson techniques. Prevalence of parasites was 25 (7.1%) with test subjects being more infected (7.6%) than  controls (6.0%) (P < 0.001). The parasites detected were Entamoeba histolytica/dispar (7.8%), Ascaris lumbricoides (4.2%), Gairdia intestinalis (1.2%), Cryptosporidium parvum (0.6%), and Hookworm (0.4%). Parasite positive subjects had significantly lower mean CD4 count (373.3±275.6 c/μl) than their parasite negative counterpart (626.7±337.6 c/μl), P = 0.028, and likewise in the control group.  HIV/parasite infected subjects on ART had significantly lower mean CD4 count (391.8±270 c/μl) than HIV/parasite negative subjects on ART (659.8±331.1), P = 0.01. Intestinal parasitoses may aggravate CD4 reduction in HIV/AIDS patients even when on  HAART, hence undermine the potency of ART and hinder their successful management. Screening tests before baseline treatment for HIV/AIDS patients should include parasitological diagnosis.