Albendazole chemotherapy for AIDS-related diarrhoea in Zambia--clinical, parasitological and mucosal responses.
BACKGROUND
Albendazole reduces diarrhoea in African AIDS patients, but it is unclear if the clinical response to treatment reflects pathogen eradication and/or mucosal recovery.


METHODS
Adults with HIV-related persistent diarrhoea were treated with albendazole 800 mg twice daily for 14 days. Clearance of parasites was evaluated at 3 and 6 weeks by stool microscopy. At baseline and at 6 weeks duodenal biopsies were taken for electron microscopy (EM) and morphometry.


RESULTS
Ten (7%) of 153 patients had cryptosporidiosis, 54 (37%) had isosporiasis and 23 (16%) had microsporidiosis. By 3 weeks, these protozoa were cleared in 27 (46%) of 59 patients initially positive. By 6 weeks, 34 (39%) of 87 patients experienced complete clinical response, 18 (21%) partial response and 35 (40%) no response. Crypt depth increased by 15% over 6 weeks (P < 0.001), but villous height increased only in patients with complete response (median + 50 microm, interquartile range (IQR) 2-90, compared to patients with partial (+ 4 microm, IQR -15,41) or no response (-13 microm, IQR -2,12; P=0.008)). Fifteen patients died: body mass index < 17.5 kg/m(2) and crypt depth < 180 microm independently predicted death.


CONCLUSIONS
Albendazole therapy reduced the burden of protozoal infection and promoted mucosal recovery in patients with a complete clinical response.
Zulu
I
I
University of Zambia School of Medicine, University Teaching Hospital, Lusaka, Zambia.
Veitch
A
A
Sianongo
S
S
McPhail
G
G
Feakins
R
R
Farthing
M J G
MJ
Kelly
P
P
D000328:Adult; D015766:Albendazole / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D000871:Anthelmintics / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D015992:Body Mass Index; D003967:Diarrhea / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000469:parasitology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007413:Intestinal Mucosa / Q000187:drug effects / Q000469:parasitology; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D015024:Zambia
D000871:Anthelmintics; D015766:Albendazole