Intestinal parasitic infections and the level of immunosuppression in HIV seropositive individuals with diarrhoea in Kilimanjaro, Tanzania: A crosssectional study

Abstract

Background: Opportunistic and non-opportunistic intestinal parasites play a significant role in the morbidity and mortality of HIV/AIDS-infected patients. The frequency of their occurrence strongly correlates with the patient’s level of immunity. The most common clinical manifestation of these intestinal parasites is diarrhoea. Prevalence of intestinal parasites among HIV-infected patients has been found to be as high as 95%.

Objective: To determine the prevalence of intestinal parasites among HIV infected participants presenting with diarrhoea and association with CD4 cell counts, ART and cotrimoxazole prophylaxis.

Methods: A prospective cross-sectional study was conducted in four HIV clinics in Moshi district, Kilimanjaro Region, Tanzania. Stool samples were collected and analyzed from participants presenting with three or more episodes of loose stool per day or a single bloody bowel movement. The identification of parasites was done using direct microscopy and staining techniques. Demographic data, CD4 counts and stool results were recorded. Data analysis was done using STATA IC/11.1.

Results: The study included 83 adult HIV positive patients. There were 36 males (43.4%) and 47 females (56.6%), with a median age of 36 years (range 30-43). The baseline CD4 count was 150 cells/ul (range 72-295 cells/ul). Of our participants, 47 (56.6%) had a baseline CD4 cell count < 200 cell/uL. Only 6(7.2%) had CD4 counts above 500cells/uL. Of the whole group, 62(74.7%) were on ARV therapy and 33(39.8%) were on cotrimoxazole prophylaxis. Intestinal parasites were detected in 25 of our participants. Among these 25 participants, Ascaris lumbricoides was found in 52%, Giardia lamblia in 32% and Entamoeba histolytica in 16%. The frequency of intestinal parasites was significantly associated with CD4 cell counts <200 cells/ul (p=0.02). There was no significant difference in parasitic infections associated with ART status or cotrimoxazole use.

Conclusion: The prevalence of parasitic infection is high in HIV-infected patients presenting with diarrhoea despite the use of ART and other prophylactic medications. Intestinal parasites should not be overlooked in HIV-infected patients presenting with diarrhoea.

Keywords: HIV, intestinal parasites, diarrhoea, immunity, Tanzania