title: Intestinal parasitic infections in relation to CD4(+) T cell counts and diarrhea in HIV/AIDS patients with or without antiretroviral therapy in Cameroon.
abstract: BACKGROUND
  Intestinal parasitic infections (IPI) are a major public health concern in HIV/AIDS patients particularly in resource-limited settings of Sub-Saharan Africa. Studies investigating the relationship between intestinal parasitic infections and CD4(+) T cell counts and diarrhea in HIV/AIDS patients with or without antiretroviral therapy in the region are not readily available hence the need to perform this study.
  
  
  METHODS
  In a comparative cross-sectional study involving 52 pre-ART and 248 on-ART HIV patients. Stool samples were collected and analysed for intestinal parasites by wet and iodine mounts, Kato-Katz, formol ether, modified field staining, and modified Ziehl-Neelsen staining techniques. Blood samples were collected and analysed for CD4(+) T cell counts by flow cytometry. A pre-tested semi-structured questionnaire was used to collect data on socio-demographic and clinical presentation. Data were analysed using STATA version 12.1. Statistical tests performed included the Pearson Chi-square, logistic regression and student's t-test. P < 0.05 was considered to be statistically significant.
  
  
  RESULTS
  The prevalence of intestinal parasitic infections in pre-ART and on-ART was 84.6% and 82.3% respectively with no significant difference observed with respect to age (p = 0.06), and gender (p = 0.736). All the opportunistic parasites including Cryptosporidium parvum, Cyclospora cayetanensis, Isospora belli and Microsporidium spp. were isolated from both groups, with only Microsporidium spp. significantly associated with CD4(+) T cell counts below 200 cells/μl in pre-ART (p = 0.006) while Cryptosporidium parvum, Microsporidium spp. and Isospora belli were associated with counts below 200 cells/μl in on-ART. Cryptosporidium parvum was significantly associated with diarrhea in pre-ART (p = 0.025) meanwhile it was significantly associated with diarrhea in on-ART (p = 0.057). The risk of diarrhea was highest in patients with CD4(+) T cell counts below 200 cells/μl (COR = 10.21, p = 0.000) for both pre- and on-ART treatment.
  
  
  CONCLUSIONS
  A very high prevalence of intestinal parasitic infections was observed, which did not differ with respect to ART status. All known opportunistic parasites were isolated in both pre-ART and on-ART patients. Low CD4(+) T cell count may appear to be a factor for intestinal parasitic infections and development of diarrhea. Regular screening and treatment of intestinal parasitic infections is very vital in improving the overall quality of care of HIV/AIDS patients.
authors.affiliation: Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Box 63, Buea, Cameroon. nsaghads@hotmail.com.
authors.forename: Dickson Shey
authors.initials: DS
authors.lastname: Nsagha
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Anna Longdoh
authors.initials: AL
authors.lastname: Njunda
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Nguedia Jules Clement
authors.initials: NJC
authors.lastname: Assob
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Charlotte Wenze
authors.initials: CW
authors.lastname: Ayima
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Elvis Asangbeng
authors.initials: EA
authors.lastname: Tanue
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Odette Dzemo
authors.initials: OD
authors.lastname: Kibu
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
authors.forename: Tebit Emmanuel
authors.initials: TE
authors.lastname: Kwenti
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002163:Cameroon; D003430:Cross-Sectional Studies; D016785:Cryptosporidium parvum / Q000302:isolation & purification; D021744:Cyclospora; D003967:Diarrhea / Q000150:complications; D005243:Feces / Q000469:parasitology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology*; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000150:complications*; D021865:Isosporiasis / Q000150:complications; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents