title: Prevalence of Strongyloides stercoralis in an urban US AIDS cohort.
abstract: OBJECTIVE
  We examined the prevalence of Strongyloides stercoralis (Ss) infection in a cohort of AIDS patients from a US urban centre. We monitored our cohort for possible cases of dissemination or immune reconstitution inflammatory syndrome after antiretroviral  therapy (ART) initiation.
  
  
  METHODS
  One hundred and three HIV-infected participants were prospectively sampled from a cohort observational study of ART-naive HIV-1-infected patients with CD4 ≤100 T cells/μl. Clinical symptoms, corticosteroid therapy, eosinophilia, CD4 count,  and plasma HIV-RNA were reviewed. Sera were tested by an enzyme-linked immunosorbent assay (CrAg-ELISA) to crude Ss extract or to an Ss-specific recombinant protein (NIE) and by luciferase immunoprecipitation system assay (LIPS) for Ss-specific antibodies.
  
  
  RESULTS
  Twenty-five per cent of study participants were Strongyloides seropositive by CrAg-ELISA and 62% had emigrated from Strongyloides-endemic areas. The remaining 38% of the seropositives were US born and tested negative by NIE and LIPS. CrAg-ELISA-positive participants had a median CD4 count  of 22 T cells/μl and a median HIV-RNA of 4·87 log(10) copies/ml. They presented with diarrhea (27%), abdominal pain (23%), and skin manifestations (35%) that did not differ from seronegative patients. Peripheral blood eosinophilia was common among seropositive patients (prevalence  of 62% compared to 29% in seronegatives, P = 0·004). Seropositive patients were treated with ivermectin. There were no cases of hyperinfection syndrome.
  
  
  CONCLUSIONS
  Strongyloidiasis may be prevalent in AIDS patients in the USA who emigrated from Ss-endemic  countries, but serology can be inconclusive, suggesting that empiric ivermectin therapy is a reasonable approach in AIDS patients originating from Strongyloides endemic areas.
authors.affiliation: National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD 20892, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Nabha
authors.forename: Sonya
authors.initials: S
authors.lastname: Krishnan
authors.forename: Roshan
authors.initials: R
authors.lastname: Ramanathan
authors.forename: Rojelio
authors.initials: R
authors.lastname: Mejia
authors.forename: Gregg
authors.initials: G
authors.lastname: Roby
authors.forename: Virginia
authors.initials: V
authors.lastname: Sheikh
authors.forename: Isabel
authors.initials: I
authors.lastname: McAuliffe
authors.forename: Thomas
authors.initials: T
authors.lastname: Nutman
authors.forename: Irini
authors.initials: I
authors.lastname: Sereti
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D000909:Antibodies, Helminth / Q000097:blood*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004797:Enzyme-Linked Immunosorbent Assay; D004802:Eosinophilia / Q000175:diagnosis; D005260:Female; D006678:HIV; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D016036:Seroepidemiologic Studies; D017171:Strongyloides stercoralis / Q000276:immunology*; D013322:Strongyloidiasis / Q000453:epidemiology* / Q000473:pathology; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D019562:Viral Load
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D044966:Anti-Retroviral Agents; D000909:Antibodies, Helminth; D012367:RNA, Viral