Parasitic diarrhoea in treatment-naïve HIV-positive patients attending the University of Ilorin Teaching Hospital (UITH) Highly Active Antiretroviral Treatment (HAART) clinic

Abstract

Background: HIV is a public health issue with diarrhoea being the commonest gastrointestinal symptom especially in individuals with lower CD4+ cell counts. Most times, parasitic infections present as diarrhoea. Depending on geographical location, the pathogens responsible for diarrhoea vary.

Aim: To relate the degree of immunodeficiency in HIV-infected patients to diarrhoea as a result of infestation by parasitic agent.

Methods: 250 HIV positive and 250 HIV negative participants were recruited. Stool and blood samples were taken from all participants. Macroscopic and microscopic examinations of the stool were done while CD4+ count was estimated from the blood sample collected. Wet preparation of stool sample was done and concentrated stool was used for modified Ziehl Neelsen staining.

Results: Diarrhoea was present in 200 participants, 118 of which were among the HIV positive group. Parasites were demonstrated in 82.3% of the test participants with diarrhoea and 17.7% of the controls with diarrhoea. Of the HIV positive with diarrhoea, 70.3% had a CD4 <200 cells/μl and 29.7% had a CD4 of 200-500cells/μl. Parasites in both groups were Ascaris lumbricoides, Balantidium coli, Entamoeba histolytica, Schistosoma mansoni, Hookworm, Strongyloides stercoralis and coccidian parasites though at varying frequencies. Of the 79 with parasites, 60 had single parasitosis, while 19 had multiple parasitosis. CD4 count was the only variable that correctly predicts presence of diarrhoea.

Conclusion: Diarrhoea associated with parasitic infection HIV patients is a function of the immune status of the individual.