Enteric opportunistic parasites in HIV positive patients and associated risk factors
DOI:
https://doi.org/10.18203/2320-6012.ijrms20253608Keywords:
Cryptosporidium, HIV, Opportunistic infections, Risk factorsAbstract
Background: Depletion of CD4+ T-cells following HIV infection leads to immune system collapse, leaving patients susceptible to opportunistic infections. In developing countries like India, parasites cause diarrhoea in over 90% of HIV patients. This study was conducted to identify the enteric opportunistic parasitic diseases that affect HIV-positive patients and associated risk factors. This study also focuses on the identification of Cryptosporidium species by conventional methods and comparing them with ELISA.
Methods: A cross-sectional study was carried out in the Department of Microbiology, GMCH, Aurangabad, from January 2023 to June 2024. Total 104 stool samples of HIV-positive patients were collected. Proper history was obtained to identify the risk factors. The samples were subjected to direct wet mount, concentrated using formalin-ether method, followed by modified Ziehl-Neelsen staining, Auramine O fluorescent staining, and ELISA.
Results: The parasites identified include Cryptosporidium (34), Cyclospora cayetanensis (1), Strongyloides stercoralis (1), and Entamoeba (1). The risk factors associated with opportunistic infections were high HIV viral load, low CD4 count, shorter duration of ART, chronic diarrhea, and occupation. Auramine O staining was identified as superior to wet mount and modified Ziehl-Neelsen staining for identification of Cryptosporidium spp.
Conclusions: Clinicians can fight AIDS more successfully with proper knowledge about opportunistic infections. Since the spectrum of opportunistic infections varies with geography, their pattern in a particular area is of utmost importance. Understanding the risk factors and optimal diagnostic techniques for opportunistic infections helps in prompt treatment, contributing to delaying the progression to AIDS.
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References
Gautam H, Bhalla P, Saini S, Uppal B, Kaur R, Baveja CP et al. Epidemiology of opportunistic infections and its correlation with CD4 T-lymphocyte counts and plasma viral load among HIV-positive patients at a tertiary care hospital in India. J Int Assoc Physicians AIDS Care (Chic). 2009;8(6):333-7. DOI: https://doi.org/10.1177/1545109709346881
The path that ends AIDS: UNAIDS Global AIDS Update 2023. Geneva: Joint United Nations Programme on HIV/AIDS; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Bhuvana KB, Hema NG, Patil RT. Prevalence and risk factors for opportunistic infections in HIV patients who developed adverse drug reactions (ADRs) to antiretroviral therapy (ART) in a tertiary-care teaching hospital. Nat J Physiol Pharm Pharmacol. 2015;5(3):200-. DOI: https://doi.org/10.5455/njppp.2015.5.0301201517
National AIDS Control Organization- ICMR- National Institute of Medical Statistics. India HIV Estimates 2021 Fact Sheet, 2021. Available at: https://naco.gov.in/sites/default/files/India%20HIV%20Estimates%202021%20_Fact%20Sheets__Final_Shared_24_08_2022_0.pdf. Accessed 01 June 2025.
Suryawanshi M, Kalshetti V, Telele K, Wadile R, Haswani N, AHIRE K. The Intestinal Parasitic Infections and the CD4 Counts in HIV Seropositive Individuals in the Dhule District in Maharashra, India. J Clin Diagnos Res. 2012;6(7).
Meng S, Tang Q, Xie Z, Wu N, Qin Y, Chen R, et al. Spectrum and mortality of opportunistic infections among HIV/AIDS patients in southwestern China. Eur J Clin Microbiol Infect Dis. 2023;42(1):113-20. DOI: https://doi.org/10.1007/s10096-022-04528-y
Council A. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents With HIV, 2024. Available at: https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-oi/guidelines-adult-adolescent-oi.pdf. Accessed 01 June 2025.
Sahu S, Mohanty I, Parida B. Parasitic enteropathogens in HIV seropositive patients in relation to CD4 count at a tertiary care hospital. Int J Clin Biomed Res. 2018;4(2):27-30. DOI: https://doi.org/10.5455/ijcbr.2018.42.06
Dwivedi KK, Prasad G, Saini S, Mahajan S, Lal S, Baveja UK. Enteric opportunistic parasites among HIV infected individuals: associated risk factors and immune status. Jap J Infect Dis. 2007;60(2-3):76-81.
Basile FW, Fedele MC, Lo Vecchio A. Gastrointestinal diseases in children living with HIV. Microorg. 2021;9(8):1572. DOI: https://doi.org/10.3390/microorganisms9081572
World Health Organization. Guidelines on standard operating procedures for laboratory diagnosis of HIV-oportunistic infections. WHO Regional Office for South-East Asia; 2001. Available at: https://iris.who.int/server/api/core/bitstreams/621d444c-d1a1-4b73-b553-9576d47d13a2/content. Accessed 01 June 2025.
Joseph AA, Ano-Edward GH. Correlation of viral load to intestinal parasitosis in HIV seropositive patients attending UITH Ilorin. Ann Trop Pathol. 2016;7(1):49-61.
Nsagha DS, Njunda LA, Assob NJ, Ayima CW, Tanue EA, Kibu OD, et al. Prevalence and predisposing factors to intestinal parasitic infections in HIV/AIDS patients in Fako division of Cameroon. Am J Epidemiol Infect Dis. 2017;5(3):42-9. DOI: https://doi.org/10.12691/ajeid-5-3-1
Endalamaw M, Alemneh A, Amare GA, Fenta A, Belew H. Magnitude of intestinal parasitic infections and its determinants among HIV/AIDS patients attending at antiretroviral treatment centers in East and West Gojam Zones, Northwest, Ethiopia: institution based cross-sectional study. AIDS Res Ther. 2024;21(1):32. DOI: https://doi.org/10.1186/s12981-024-00618-3
Barcelos NB, Silva LFE, Dias RFG, Menezes Filho HR, Rodrigues RM. Opportunistic and non-opportunistic intestinal parasites in HIV/ AIDS patients in relation to their clinical and epidemiological status in a specialized medical service in Goiás, Brazil. Rev Inst Med Trop Sao Paulo. 2018;60:e13. DOI: https://doi.org/10.1590/s1678-9946201860013
Dereb E, Negash M, Teklu T, Damtie D, Abere A, Kebede F, et al. Intestinal Parasitosis and its Association with CD4+ T Cell Count and Viral Load among People Living with HIV in Parasite Endemic Settings of Northwest Ethiopia. HIV AIDS (Auckl). 2021;13:1055-65. DOI: https://doi.org/10.2147/HIV.S328269
Kulkarni SV, Kairon R, Sane SS, Padmawar PS, Kale VA, Thakar MR, et al. Opportunistic parasitic infections in HIV/AIDS patients presenting with diarrhoea by the level of immunesuppression. Ind J Medi Res. 2009;130(1):63.
Saleem M, Sivasankaran MP, Sujitha K, Innocent JP. Identification of Opportunistic Intestinal parasites in HIV Seropositive patients attending a Tertiary care hospital in Madhurandagam, India. Int J Medi Pharma Virol. 2011;1(2):52-9.
Mohamud AK, Ahmed OA, Mohamud AA, Dirie NI. Magnitude of opportunistic infections and associated factors among adult people living with human immune deficient virus on art at selected public hospital, mogadishu somalia: cross-sectional study. Ann Med Surg (Lond). 2023;85(7):3364-71. DOI: https://doi.org/10.1097/MS9.0000000000000880
Mathur MK, Verma AK, Makwana GE, Sinha M. Study of opportunistic intestinal parasitic infections in human immunodeficiency virus/acquired immunodeficiency syndrome patients. J Global Infect Dis. 2013;5:164-7. DOI: https://doi.org/10.4103/0974-777X.122012
Gupta K, Bala M, Deb M, Muralidhar S, Sharma DK. Prevalence of intestinal parasitic infections in HIV-infected individuals and their relationship with immune status. Ind J Med Microbiol. 2013;31(2):161-5.
Vyas N, Sood S, Sharma B, Kumar M. The Prevalence of Intestinal Parasitic Infestation and the Related Profile of the CD4 (+) Counts in HIV/AIDS People with Diarrhoea in Jaipur City. J Clin Diagn Res. 2013;7(3):454-6. DOI: https://doi.org/10.7860/JCDR/2013/4817.2797
Mohandas K, Sehgal R, Sud A, Malla N. Prevalence of intestinal parasitic pathogens in HIV-seropositive individuals in Northern India. Japan J Infect Dis. 2002;55(3):83-4. DOI: https://doi.org/10.7883/yoken.JJID.2002.83
Mehta KD, Vacchani A, Mistry MM, Kavathia GU, Goswami YS. To study the prevalence of various enteric parasitic infections among HIV infected individuals in the P.D.U. Medical College and Hospital, Rajkot, Gujarat, India. J Clin Diagn Res. 2013;7(1):58-60. DOI: https://doi.org/10.7860/JCDR/2012/4864.2670
Purbey MK, Singh A, Kumari S, Banerjee T. High carriage rate of intestinal parasites among asymptomatic HIV-seropositive individuals on antiretroviral therapy attending the tertiary care hospital in Varanasi, India. Indian J Sex Transm Dis AIDS. 2021;42(2):101-5. DOI: https://doi.org/10.4103/ijstd.IJSTD_39_18
Mohanty I, Panda P, Sahu S, Dash M, Narasimham MV, Padhi S, et al. Prevalence of isosporiasis in relation to CD4 cell counts among HIV-infected patients with diarrhea in Odisha, India. Adv Biomed Res. 2013;2:61. DOI: https://doi.org/10.4103/2277-9175.115810
Ghazali WA, Al-Talib H, Zaini AB. Microsporidiosis: Identification by a simple modified trichrome stain. Int J Infect Dis. 2020;101:430-6. DOI: https://doi.org/10.1016/j.ijid.2020.09.1129
Abange WB, Nkenfou CN, Gonsu Kamga H, Nguedia CA, Kamgaing N, Lozupone C, et al. Intestinal parasites infections among HIV infected children under antiretrovirals treatment in Yaounde, Cameroon. J Trop Pediatr. 2020;66(2):178-86. DOI: https://doi.org/10.1093/tropej/fmz048
Zeynudin A, Hemalatha K, Kannan S. Prevalence of opportunistic intestinal parasitic infection among HIV infected patients who are taking antiretroviral treatment at Jimma Health Center, Jimma, Ethiopia. Eur Rev Med Pharmacol Sci. 2013;17(4):513-6.
Ringo TA, Ernest A, Kamala B, Mpondo BC. Intestinal parasitic infections and the level of immunosuppression in HIV seropositive individuals with diarrhoea in Kilimanjaro, Tanzania: A crosssectional study. South Sudan Med J. 2015;8(3):52-6.
Awole M, Gebre-Selassie S, Kassa T, Kibru G. Prevalence of intestinal parasites in HIV-infected adult patients in southwestern Ethiopia. Ethiop J Health Dev. 2003;17(1):71-8. DOI: https://doi.org/10.4314/ejhd.v17i1.9783
Akinbo FO, Okaka CE, Omoregie R. Prevalence of intestinal parasitic infections among HIV patients in Benin City, Nigeria. Libyan J Medi. 2010;5(1). DOI: https://doi.org/10.3402/ljm.v5i0.5506
Alemseged M, Abebe R, Girma M. Prevalence and associated risk factors of opportunistic intestinal parasites among HIV positive and negative individuals in South Ethiopia: a case control study. BAOJ Hiv. 2015;1(001). DOI: https://doi.org/10.24947/baojh/1/1/101
Alemayehu E, Gedefie A, Adamu A, Mohammed J, Kassanew B, Kebede B, et al. Intestinal parasitic infections among HIV-infected patients on antiretroviral therapy attending debretabor general hospital, Northern Ethiopia: a cross-sectional study. HIV AIDS (Auckl). 2020;12:647-55. DOI: https://doi.org/10.2147/HIV.S275358
Dwivedi KK, Prasad G, Saini S, Mahajan S, Lal S, Baveja UK. Enteric opportunistic parasites among HIV infected individuals: associated risk factors and immune status. Jpn J Infect Dis. 2007;60(2-3):76-81. DOI: https://doi.org/10.7883/yoken.JJID.2007.76
Omoruyi BE, Nwodo UU, Udem CS, Okonkwo FO. Comparative diagnostic techniques for Cryptosporidium infection. Molecules. 2014;19(2):2674-83. DOI: https://doi.org/10.3390/molecules19022674
Ninama A. Detection of Cryptosporidium in fecal sample by three staining method from immunocompromised patients. Int J Med Microbiol Trop Dis. 2018;4(4):257-60. DOI: https://doi.org/10.18231/2581-4761.2018.0055
Jaiswal V, Brar APS, Sandhu BS, Singla LD, Narang D, Leishangthem GD, et al. Comparative evaluation of various diagnostic techniques for detection of Cryptosporidium infection from the faecal samples of diarrhoeic bovine calves. Iran J Vet Res. 2022;23(3):247-54.
Hanscheid T, Cristino JM, Salgado MJ. Screening of auramine-stained smears of all fecal samples is a rapid and inexpensive way to increase the detection of coccidial infections. Int J Infect Dis. 2008;12(1):47-50. DOI: https://doi.org/10.1016/j.ijid.2007.04.008
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