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Original Article

Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4+ T-cell Count and Diarrhea in HIV Patients

Shehla Khalil1, Bijay Ranjan Mirdha1,*, Sanjeev Sinha2, Ashutosh Panda1, Yogita Singh1, Anju Joseph1, Manorama Deb3
The Korean Journal of Parasitology 2015;53(6):705-712.
Published online: December 31, 2015

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*Corresponding author (mirdhabr2078@gmail.com)
• Received: April 30, 2015   • Revised: September 3, 2015   • Accepted: September 9, 2015

© 2015, Korean Society for Parasitology and Tropical Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4+ T-cell Count and Diarrhea in HIV Patients
Korean J Parasitol. 2015;53(6):705-712.   Published online December 31, 2015
DOI: https://doi.org/10.3347/kjp.2015.53.6.705
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Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4+ T-cell Count and Diarrhea in HIV Patients
Korean J Parasitol. 2015;53(6):705-712.   Published online December 31, 2015
DOI: https://doi.org/10.3347/kjp.2015.53.6.705
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Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4+ T-cell Count and Diarrhea in HIV Patients
Image Image Image Image Image Image Image Image Image
Fig. 1. Modified acid fast staining showing oocysts of (A) Cryptosporidium species (4-8 μm in diameter), (B) Cyclospora cayetanensis (8-10 μm in diameter), and (C) Cystoisospora belli (20-30 by 10-15 μm in size).
Fig. 2. Modified trichrome staining showing spores of microsporidia (1-2 μm in diameter).
Fig. 3. PCR assay for 18S rRNA gene of Cryptosporidium spp. Lane 1, negative control; lanes 2-3, positive samples; lane 4, positive control; lane 5, 100 bp molecular marker; lane 6, blank.
Fig. 4. PCR assay for 18S rRNA gene of Cyclospora cayetanensis. Lane 1, negative control; lanes 2-4, positive samples; lane 5, 50 bp molecular marker.
Fig. 5. PCR assay for internal round of 18S rRNA gene of Cystoisospora belli. Lane 1, blank; lane 2, negative control; lanes 3-4, positive samples; lane 5, 100 bp molecular marker.
Fig. 6. PCR assay for 18S rRNA gene of Enterocytozoon bieneusi (microsporidia). Lane 1, positive control; lane 2, positive sample; lane 3, 100 bp molecular marker; lane 4, negative control.
Fig. 7. No. of patients with acute diarrhea and chronic diarrhea amongst HIV infected and HIV uninfected cases with diarrhea.
Fig. 8. No. of parasites in patients with acute diarrhea and chronic diarrhea stratified on the basis of CD4+ T-cell count among HIV seropositive individuals.
Fig. 9. Distribution of patients in relation to CD4+ T-cell count and the presence of parasites.

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

Intestinal Parasitosis in Relation to Anti-Retroviral Therapy, CD4+ T-cell Count and Diarrhea in HIV Patients
Variables No. Percentage (%)
Age (Median) in years 36 -
Gender
 Male 132 66
 Female 68 44
Risk Factor
 Heterosexual 178 89
 Blood Transfusion 11 5
 Needle Prick 3 2
 Unknown 8 4
Parasite (P-value) Cumulative no. of positive patientsa (n=400) No. of parasite positives among cases (n=200) No. of parasite positives among controls (n=200)
Opportunistic parasites 15 15 -
 Cryptosporidium spp. (0.01) 3 1 2
 Cyclospora Cayetanensis 15 15 -
 Cystoisospora belli (0.01) 5 5 -
 Strongyloides stercoralis 5 5 -
 Enterocytozoon bieneusi
Non-opportunistic, pathogenic parasites
 Giardia intestinalis 32 18 14
 Entamoeba histolytica/E. dispar 15 8 7
 Ascaris lumbricoides 2 1 1
 Hymenolepis nana 10 6 4
Non-opportunistic, non-pathogenic parasites
 Entamoeba coli 11 6 5
 Endolimax nana 9 4 5
 Blastocystis hominis 30 14 16
Cases, HIV seropositive (n=200)
 Controls, HIV uninfected (n=200)
On ART with diarrhea (n=100) (%) ART naive without diarrhea (n=100) (%) With diarrhea (n=100) (%) Without diarrhea (n=100) (%)
Opportunistic parasites
Cryptosporidium spp. 12 3 - -
Cyclospora cayetanensis 1 - 2 -
Cystoisospora belli 10 5 - -
Strongyloides stercoralis 5 - - -
Enterocytozoon bieneusi 5 - - -
Non-opportunistic, pathogenic parasites
Giardia intestinalis 11 7 9 5
Entamoeba histolytica/E. dispar 6 2 6 1
Ascaris lumbricoides 1 - 1 -
Hymenolepis nana 3 3 4 -
Non-opportunistic, non-pathogenic parasites
Entamoeba coli 4 2 3 2
Endolimax nana 2 2 3 2
Blastocystis hominis 10 4 12 4
Table 1. Demographic details and risk factors of HIV seropositive patients
Table 2. Distribution of intestinal parasites between cases and controls

130 (32.5%) of 400 patients were positive for any kinds of intestinal parasites.

Table 3. Percentage of patients infected with different types of parasites in each subgroup

Table 1.

Table 2.

Table 3.

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