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Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era.
Int J Infect Dis. 2012 Sep; 16(9):e677-9.IJ

Abstract

BACKGROUND

The use of combination antiretroviral therapy (cART) has dramatically reduced the prevalence of opportunistic infections, however data on the prevalence of intestinal parasitic infections in HIV-infected patients with low CD4 cell counts in the cART era are scarce.

METHODS

We performed a prospective cohort study among HIV-infected patients with CD4 cell counts <100/mm(3) seen at a university hospital in Paris. Medical records were reviewed and stool samples were obtained for macroscopic examination and detection of parasites including cryptosporidia and microsporidia, whether or not the patient had diarrhea. Stool cultures were performed for patients with diarrhea. Factors associated with the detection of parasites were then identified.

RESULTS

Stools samples from 143 consecutive patients were analyzed. Patients were mostly men (76%), and the median patient age was 41 years. The median CD4 cell count was 32/mm(3), and 59% were receiving cART. Diarrhea was present in 85 patients (59%), 19 of whom (22%) had intestinal parasites detected in stools. Three patients with diarrhea were diagnosed with Salmonella typhimurium, Campylobacter coli, and Clostridium difficile infections. Among the 58 patients without diarrhea, parasitic intestinal pathogens were still identified in six (10%). The overall prevalence of intestinal parasites was 17%, with cryptosporidia (n=8), microsporidia (n=6), and Giardia duodenalis (n=5) being the most frequent pathogens. Patients with intestinal parasites had diarrhea more often (76% vs. 56%, p=0.025) and were more often at US Centers for Disease Control and Prevention (CDC) clinical stage C (84% vs. 69%, p=0.024) than patients without parasites.

CONCLUSIONS

The prevalence of intestinal parasitic infections remains significant in HIV-infected patients with low CD4 counts in the cART era. A systematic search for parasitic pathogens including microsporidia, cryptosporidia, and G. duodenalis should be performed even in the absence of diarrhea.

Authors+Show Affiliations

Department of Infectious Diseases, Saint-Louis Hospital and University of Paris Diderot Paris 7, 1 avenue Claude Vellefaux, 75010 Paris, France. juliette.pavie@egp.aphp.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22771183

Citation

Pavie, Juliette, et al. "Prevalence of Opportunistic Intestinal Parasitic Infections Among HIV-infected Patients With Low CD4 Cells Counts in France in the Combination Antiretroviral Therapy Era." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 16, no. 9, 2012, pp. e677-9.
Pavie J, Menotti J, Porcher R, et al. Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era. Int J Infect Dis. 2012;16(9):e677-9.
Pavie, J., Menotti, J., Porcher, R., Donay, J. L., Gallien, S., Sarfati, C., Derouin, F., & Molina, J. M. (2012). Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 16(9), e677-9. https://doi.org/10.1016/j.ijid.2012.05.1022
Pavie J, et al. Prevalence of Opportunistic Intestinal Parasitic Infections Among HIV-infected Patients With Low CD4 Cells Counts in France in the Combination Antiretroviral Therapy Era. Int J Infect Dis. 2012;16(9):e677-9. PubMed PMID: 22771183.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era. AU - Pavie,Juliette, AU - Menotti,Jean, AU - Porcher,Raphaël, AU - Donay,Jean Luc, AU - Gallien,Sébastien, AU - Sarfati,Claudine, AU - Derouin,Francis, AU - Molina,Jean-Michel, Y1 - 2012/07/06/ PY - 2012/01/04/received PY - 2012/05/14/accepted PY - 2012/7/10/entrez PY - 2012/7/10/pubmed PY - 2013/3/30/medline SP - e677 EP - 9 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int. J. Infect. Dis. VL - 16 IS - 9 N2 - BACKGROUND: The use of combination antiretroviral therapy (cART) has dramatically reduced the prevalence of opportunistic infections, however data on the prevalence of intestinal parasitic infections in HIV-infected patients with low CD4 cell counts in the cART era are scarce. METHODS: We performed a prospective cohort study among HIV-infected patients with CD4 cell counts <100/mm(3) seen at a university hospital in Paris. Medical records were reviewed and stool samples were obtained for macroscopic examination and detection of parasites including cryptosporidia and microsporidia, whether or not the patient had diarrhea. Stool cultures were performed for patients with diarrhea. Factors associated with the detection of parasites were then identified. RESULTS: Stools samples from 143 consecutive patients were analyzed. Patients were mostly men (76%), and the median patient age was 41 years. The median CD4 cell count was 32/mm(3), and 59% were receiving cART. Diarrhea was present in 85 patients (59%), 19 of whom (22%) had intestinal parasites detected in stools. Three patients with diarrhea were diagnosed with Salmonella typhimurium, Campylobacter coli, and Clostridium difficile infections. Among the 58 patients without diarrhea, parasitic intestinal pathogens were still identified in six (10%). The overall prevalence of intestinal parasites was 17%, with cryptosporidia (n=8), microsporidia (n=6), and Giardia duodenalis (n=5) being the most frequent pathogens. Patients with intestinal parasites had diarrhea more often (76% vs. 56%, p=0.025) and were more often at US Centers for Disease Control and Prevention (CDC) clinical stage C (84% vs. 69%, p=0.024) than patients without parasites. CONCLUSIONS: The prevalence of intestinal parasitic infections remains significant in HIV-infected patients with low CD4 counts in the cART era. A systematic search for parasitic pathogens including microsporidia, cryptosporidia, and G. duodenalis should be performed even in the absence of diarrhea. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/22771183/Prevalence_of_opportunistic_intestinal_parasitic_infections_among_HIV_infected_patients_with_low_CD4_cells_counts_in_France_in_the_combination_antiretroviral_therapy_era_ L2 - http://linkinghub.elsevier.com/retrieve/pii/S1201-9712(12)01174-5 DB - PRIME DP - Unbound Medicine ER -