title: Prevalence of opportunistic intestinal parasitic infections among HIV-infected patients with low CD4 cells counts in France in the combination antiretroviral therapy era.
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: 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.fr
authors: Juliette
authors: J
authors: Pavie
authors: Jean
authors: J
authors: Menotti
authors: Raphaël
authors: R
authors: Porcher
authors: Jean Luc
authors: JL
authors: Donay
authors: Sébastien
authors: S
authors: Gallien
authors: Claudine
authors: C
authors: Sarfati
authors: Francis
authors: F
authors: Derouin
authors: Jean-Michel
authors: JM
authors: Molina
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000276:immunology / Q000469:parasitology*; D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003458:Cryptosporidium / Q000276:immunology / Q000302:isolation & purification*; D016054:DNA, Protozoan / Q000737:chemistry / Q000235:genetics; D005243:Feces / Q000469:parasitology; D005260:Female; D006678:HIV / Q000276:immunology*; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology / Q000469:parasitology* / Q000821:virology; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology / Q000276:immunology / Q000469:parasitology / Q000821:virology*; D008297:Male; D016814:Microsporidia / Q000276:immunology / Q000302:isolation & purification*; D010297:Paris / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D016054:DNA, Protozoan