Enteric parasitic infections in HIV/AIDS patients before and after the highly active antiretroviral therapy

ABSTRACT

Enteroparasites are related to gastrointestinal alterations among patients with HIV/AIDS, some causing severe manifestations in the period before the institution of the highly active antiretroviral therapy (HAART). The prevalence of enteroparasitoses in patients with HIV/AIDS seen at two hospitals in Ceará , Brazil, was compared in the pre-HAART (Group 1; n = 482) and HAART (Group 2; n = 100) eras. Fecal parasitologic examinations (FPE) were performed using the direct, Lutz, Baermann-Moraes and modified Ziehl-Neelsen methods. The following parasites were detected in Groups 1 and 2, respectively: Strongyloides stercoralis - 30.1 percent and 11 percent (p<0.0001), Ascaris lumbricoides - 15.6 percent and 2 percent (p<0.0001), hookworms - 13.7 percent and 2 percent (p<0.0001), Trichuris trichiura - 13.1 percent and 1 percent (p<0.0001), Hymenolepis nana - 0 and 1 percent (p = 0.1718), Giardia duodenalis - 7.9 percent and 1 percent (p = 0.0076), Entamoeba histolytica/dispar - 3.3 percent and 1 percent (p = 0.3301), Isospora belli - 4.8 percent and 1 percent (p = 0.0993), Cryptosporidium sp. - 8.1 percent and 0 (p = 0.0007), and non-pathogenic protozoans as well. There was a significant reduction in the prevalence of enteroparasites between the eras (63.9 percent to 24 percent; p<0.0001). In the HAART era, the following observations were made: greater frequency of enteroparasites in patients without antiretroviral therapy (p = 0.0575), as in those with AIDS (p = 0.08), and diarrhea (36 percent of the patients); lack of association with positive FPE (p = 0.626); and non-detection of Cryptosporidium sp. Strongyloides stercoralis showed an elevated prevalence in the two eras and was more frequent in men (32.41 percent) than women (19.04 percent) of Group 1 (p = 0.018), a finding suggesting the transmission of the helminth through sodomy. The advent of the HAART modified the profile of opportunistic infections, including parasites, probably due...