title: Intestinal parasitic infections in HIV-infected patients, Lao People's Democratic Republic.
abstract: BACKGROUND
  HIV infection is an emerging problem in Laos. We conducted the first prospective study on intestinal parasites, including opportunistic protozoa, in newly diagnosed HIV infected patients, with or without diarrhea. The aims were to describe the spectrum of infections, to determine their prevalence and to assess their associations with diarrhea, CD4 cell count, place of residence and living conditions.
  
  
  METHODS
  One to three stool samples over consecutive days were obtained from 137 patients. The Kato thick smear method, formalin-ethyl concentration and specific stains for coccidia and microsporidia diagnosis were performed on 260 stool samples. Baseline characteristics regarding relevant demographics, place of residence and living conditions, clinical features including diarrhea, were collected using a standardized questionnaire.
  
  
  RESULTS
  The 137 patients were young (median age: 36 years) and severely immunocompromised (83.9% at WHO stage 3 or 4, median CD4 cell count: 41/mm3). Diarrhea was present in 43.0% of patients. Parasite infection was found in 78.8% of patients, infection with at least two species in 49.6%. Prevalence rates of protozoan and helminth infections were similar (54.7% and 58.4% respectively). Blastocystis sp. was the most frequent protozoa (26.3%). Cryptosporidium sp., Cytoisospora belli and microsporidia, found at low prevalence rates (6.6%, 4.4%, 2.9%, respectively), were described for the first time in Laos. Cryptosporidium sp. was associated with persistent diarrhea. Strongyloides stercoralis was the most prevalent helminth following Opisthorchis viverrini (20.4% and 47.5% respectively). The most immunocompromised patients, as assessed by a CD4 count ≤ 50 cells/mm3, were more likely to be infected with intestinal parasites.
  
  
  CONCLUSIONS
  HIV infection was mainly diagnosed at an advanced stage of immunosuppression in Lao patients. Intestinal parasite infections were highly prevalent regardless of their diarrheal status. Opportunistic infections were reported. Improving the laboratory diagnosis of intestinal parasite infections and the knowledge on their local risk factors is warranted.
authors.affiliation: Centre d'Infectiologie Christophe Mérieux du Laos, Ministry of Health, Vientiane, Lao People's Democratic Republic; UMI 233, Institut de Recherche pour le Développement - Université Montpellier 1, Montpellier, France.
authors.forename: Phimpha
authors.initials: P
authors.lastname: Paboriboune
authors.affiliation: Department of Parasitology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.
authors.forename: Niranh
authors.initials: N
authors.lastname: Phoumindr
authors.affiliation: Faculté de Médecine Lyon-Sud Charles Mérieux, Université Lyon 1, Lyon, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Borel
authors.affiliation: Department of Infectious Diseases, Provincial Hospital, Savannakhet, Lao People's Democratic Republic.
authors.forename: Khamphang
authors.initials: K
authors.lastname: Sourinphoumy
authors.affiliation: Department of Infectious Diseases, Setthatirath Hospital, Vientiane, Lao People's Democratic Republic.
authors.forename: Saykham
authors.initials: S
authors.lastname: Phaxayaseng
authors.affiliation: Service de Parasitologie, Hospices Civils de Lyon, Lyon, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Luangkhot
authors.affiliation: Department of Parasitology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.
authors.forename: Bouachanh
authors.initials: B
authors.lastname: Sengphilom
authors.affiliation: Department of Parasitology, University of Health Sciences, Vientiane, Lao People's Democratic Republic.
authors.forename: Yathmany
authors.initials: Y
authors.lastname: Vansilalom
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Odermatt
authors.affiliation: UMI 233, Institut de Recherche pour le Développement - Université Montpellier 1, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Delaporte
authors.affiliation: UMI 233, Institut de Recherche pour le Développement - Université Montpellier 1, Montpellier, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Etard
authors.affiliation: Faculté de Médecine Lyon-Sud Charles Mérieux, Université Lyon 1, Lyon, France; Service de Parasitologie, Hospices Civils de Lyon, Lyon, France.
authors.forename: Meja
authors.initials: M
authors.lastname: Rabodonirina
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D003967:Diarrhea / Q000150:complications; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications* / Q000453:epidemiology* / Q000276:immunology; D007812:Laos / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012111:Residence Characteristics / Q000706:statistics & numerical data