title: Isosporiasis in patients with HIV infection in the highly active antiretroviral therapy era in France.
abstract: BACKGROUND
  Isosporiasis, a rare cause of diarrhoea among HIV-infected patients in the pre-highly active antiretroviral therapy (HAART) era, seems to be re-emerging.
  
  
  METHODS
  A retrospective study was carried out for the period 1995-2003 in two hospitals in Paris to describe the prevalence, clinical characteristics and therapeutic outcome of isosporiasis in HIV-infected patients, and to compare the findings with those for cryptosporidiosis and microsporidiosis.
  
  
  RESULTS
  The prevalence of isosporiasis increased from 0.4 per 1000 patients in the pre-HAART era (1995-1996) to 4.4 per 1000 patients in the HAART era (2001-2003), whereas the prevalence of cryptosporidiosis and microsporidiosis decreased. Compared with patients with either cryptosporidiosis (n=91) or microsporidiosis (n=58), patients with isosporiasis (n=28) more frequently originated from sub-Saharan Africa (72%), were more frequently female and heterosexual, and had a higher median CD4 count at diagnosis (142 cells/microL). All patients with isosporiasis presented with diarrhoea, which was severe enough to lead to hospital admission for 60% of them. Fever was uncommon (7%). All patients were treated for isosporiasis, 27 of them with cotrimoxazole. Relapse of isosporiasis occurred in six of 16 patients (38%) despite maintenance cotrimoxazole therapy and HAART.
  
  
  CONCLUSIONS
  Isosporiasis in France occurs mostly in patients emigrating from sub-Saharan Africa and can induce severe diarrhoea. Relapse is common despite cotrimoxazole maintenance therapy.
authors.affiliation: Department of Infectious Diseases, Hôpital Saint Louis, Paris, France. marie.lagrange@sls.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Lagrange-Xélot
authors.forename: R
authors.initials: R
authors.lastname: Porcher
authors.forename: C
authors.initials: C
authors.lastname: Sarfati
authors.forename: N
authors.initials: N
authors.lastname: de Castro
authors.forename: O
authors.initials: O
authors.lastname: Carel
authors.forename: J-D
authors.initials: JD
authors.lastname: Magnier
authors.forename: V
authors.initials: V
authors.lastname: Delcey
authors.forename: J-M
authors.initials: JM
authors.lastname: Molina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003967:Diarrhea / Q000453:epidemiology / Q000469:parasitology / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D021865:Isosporiasis / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010297:Paris / Q000453:epidemiology; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination