How common is intestinal parasitism in HIV-infected patients in Malaysia?

Department of Parasitology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur.
Tropical biomedicine (Impact Factor: 0.82). 08/2011; 28(2):400-10.
Source: PubMed

ABSTRACT Human immunodeficiency virus (HIV)-infected individuals have greater susceptibility to infections by a myriad of microorganisms which can cause significant morbidity and mortality compared to immunocompetent individuals. Of these microbial infections, intestinal parasitic infections (IPIs) however are receiving less attention than bacterial and viral infections, hence, the lack of information of parasitic infections in HIV individuals. Prevalence of IPIs among 346 HIV-infected individuals in Malaysia was determined in this study. The overall prevalence of intestinal parasitic infections (IPIs) was 37.9% (131 of 346) with protozoa infections (18.8%) being more common compared to helminth infections (7.5%). Observed protozoa include Entamoeba histolytica/dispar (16.8%), Cryptosporidium parvum (12.4%), Isospora belli (10.1%), Cyclospora cayetanensis (4.9%) and Giardia duodenalis (intestinalis) (3.2%) whilst helminthes which were detected comprised of Ascaris lumbricoides (13.9%), Trichuris trichiura (6.4%) and hookworms (0.6%). Among those 131 infected, 50.4% had multiple infections and 48.9% had single parasitic infection. The CD4 counts were significantly lower (i.e., 200 cells/mm³) in patients harbouring IPIs. Of those individuals infected with intestinal parasites, 49% were intravenous drug users and 58% were not on any antiretroviral therapy. Most were asymptomatic and had concurrent opportunistic infections (OIs) mainly with Mycobacterium tuberculosis infection. These results confirmed that IPIs are ubiquitous among HIV-infected individuals, especially those presenting with low CD4 T cells counts, and provide useful insights into the epidemiology of these infections among HIV-infected patients in Malaysia. It is therefore recommended, that diagnosis of these intestinal parasitic pathogens should be conducted on a routine basis for better management of gastrointestinal illnesses among HIV individuals.


Available from: Johari Surin, Apr 18, 2015
1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Two hundred fifty seven articles related to HIV/AIDS were found in a search through a database dedicated to indexing all original data relevant to medicine published in Malaysia between the years 2000–2013. One hundred seventy one articles were selected and reviewed on the basis of clinical relevance and future research implications. This review of literature has been divided into six sections, namely, epidemiology, risk behaviour, clinical features and opportunistic infections, management, diagnosis and discussion. Wherever possible, the reviewed articles have been presented in a chronological order to provide a historical perspective to the reader as many of the results of earlier publications, which are common knowledge now, were relatively unknown then. Since the early days of the HIV epidemic in Malaysia, there have been rapid advances in the understanding and the management of the epidemic in Malaysia based on the insights derived from the results of these research. These insights are invaluable tools for policy makers, advocators, healthcare providers, researchers and everyone and anyone who are involved in the care of individuals with HIV/AIDS. Attempts have been made to identify gaps in certain research areas with the hope of providing directions for future research in HIV/AIDS in Malaysia.
    The Medical journal of Malaysia 08/2014; 69(Supp A):68-81.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cryptosporidiosis, resulting from infection with the protozoan parasite Cryptosporidium , is a significant opportunistic disease among HIV-infected individuals. With multiple routes of infection due to the recalcitrant nature of its infectious stage in the environment, the formulation of effective and practical control strategies for cryptosporidiosis must be based on a firm understanding of its epidemiology. Prevalence data and molecular characterization of Cryptosporidium in HIV-infected individuals is currently available from numerous countries in Africa, Asia, Europe, North America and South America, and it is clear that significant differences exist between developing and developed regions. This review highlights the current global status of Cryptosporidium infections among HIV-infected individuals, and puts forth a contextual framework for the development of integrated surveillance and control programs for cryptosporidiosis in immune compromised patients. Given that there are few specific chemotherapeutic agents available for cryptosporidiosis, and therapy is largely based on improving the patient’s immune status, the focus should be on patient compliance and non-compliance obstacles to the effective delivery of health care, as well as educating HIV-infected individuals in the prevention of infection. This would require close collaborations amongst public health professionals, governmental officials, researchers, epidemiologists and clinicians, as well as the targeted HIV-infected individuals themselves
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Intestinal parasites (IPs) are major concerns in most developing countries where HIV/AIDS cases are concentrated and almost 80% of AIDS patients die of AIDS-related infections. In the absence of highly active antiretroviral therapy (HAART), HIV/AIDS patients in developing countries unfortunately continue to suffer from the consequences of opportunistic and other intestinal parasites. The aim of the study was to determine the prevalence of intestinal parasites in relation to CD4+ T cells levels and anemia among HAART initiated and HAART naïve pediatric HIV patients in a Model ART center in Addis Ababa, Ethiopia. A prospective comparative cross-sectional study was conducted among HAART initiated and HAART naive pediatric HIV/AIDS patients attending a model ART center at Zewditu Memorial Hospital between August 05, 2013 and November 25, 2013. A total of 180 (79 HAART initiated and 101 HAART naïve) children were included by using consecutive sampling. Stool specimen was collected and processed using direct wet mount, formol-ether concentration and modified Ziehl-Neelsen staining techniques. A structured questionnaire was used to collect data on socio-demographic and associated risk factors. CD4+ T cells and complete blood counts were performed using BD FACScalibur and Cell-Dyn 1800, respectively. The data was analyzed by SPSS version 16 software. Logistic regressions were applied to assess any association between explanatory factors and outcome variables. P values < 0.05 were taken as statistically significant. The overall prevalence of IPs was 37.8% where 27.8% of HAART initiated and 45.5% of HAART naive pediatric HIV/AIDS patients were infected (p < 0.05). Cryptosporidium species, E. histolytica/dispar, Hook worm and Taenia species were IPs associated with CD4+ T cell counts <350 cells/μμL in HAART naive patients. The overall prevalence of anemia was 10% in HAART and 31.7% in non-HAART groups. Hook worm, S. stercoralis and H. nana were helminthes significantly associated with anemia in non-HAART patients [AOR, 95% CI: 4.5(1.3, 15.2), P< 0.05]. The prevalence of IPs in non-HAART patients was significantly associated with eating unwashed/raw fruit [AOR, 95%CI: 6.3(1.2, 25.6), P<0.05], open field defecation [AOR, 95%CI: 9.3(1.6, 53.6), P<0.05] and diarrhea [AOR, 95%CI: 5.2(1.3, 21.3), P<0.05]. IPs significantly increased in rural residents [AOR, 95%CI: 0.4(0.1, 0.9, P<0.05)]. The overall prevalence of intestinal parasites significantly differed by HAART status and cryptosporidium species were found only in HAART naïve patients with low CD4+ T cell counts. Anemia was also more prevalent and significantly associated with IPs in non-HAART patients. This study identified some environmental and associated risk factors for intestinal parasitic infections. Therefore, Public health measures should continue to emphasize the importance of environmental and personal hygiene to protect HIV/AIDS patients from infections with intestinal parasites and maximize the benefits of HAART.
    PLoS ONE 02/2015; 10(2-2). DOI:10.1371/journal.pone.0117715 · 3.53 Impact Factor