title: Enteric parasitic infection among HIV-infected patients visiting Tribhuvan University Teaching Hospital, Nepal.
abstract: BACKGROUND
  Enteric parasitic infection among human immunodeficiency virus (HIV) patients has been a significant health problem in developing countries like Nepal. This study was undertaken to access the burden of enteric parasites among HIV patients and its association with their immune status.
  
  
  METHODS
  A cross-sectional study, involving 112 HIV sero-positive patients was conducted in Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal from July 2011 to June 2012. The fecal samples were processed by direct-smear technique, in both normal saline solution and 1% iodine solution as well as modified acid fast staining (Kinyoun's method) after formalin ether concentration and Sheather's sucrose flotation for the identification of enteric parasites.
  
  
  RESULTS
  Infection with one or more parasite was seen in 33.9% (n = 38) of the cases enrolled in the study, with the parasite prevalence rate of 41.1% (n = 46). Literacy (OR = 1.9, 95% CI 0.9-4.3) and CD4 T-cell count <200 (OR = 2.5, 95% CI 1.1-5.7) were found to be associated with enteric parasite infection. Similarly, CD4 T-cell count <200 was found to be associated with opportunistic parasitic infection (OR = 3.2, 95% CI 1.2-7.8). Among opportunistic parasites, Giardia duodenalis was the most common (28.3%, n = 13) one. Multi-parasitism was observed in six patients (15.8%).
  
  
  CONCLUSIONS
  Enteric parasitic infections are common in HIV-infected people. The poor immune status as indicated by low CD4 T-cell count may account for higher risk of both opportunistic and non-opportunistic enteric parasitic infection.
authors.affiliation: Blood Transfusion Service, Department of Pathology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Ananda
authors.initials: A
authors.lastname: Ghimire
authors.affiliation: Nutrition Innovation Lab, Nepal/Johns Hopkins University, Patan Dhoka, Lalitpur, Kathmandu, Nepal.
authors.forename: Shiva
authors.initials: S
authors.lastname: Bhandari
authors.affiliation: Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Tandukar
authors.affiliation: Department of Microbiology, Trichandra Multiple College, Ghantaghar, Kathmandu, Nepal.
authors.forename: Jyoti
authors.initials: J
authors.lastname: Amatya
authors.affiliation: Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal. me.dinesh43@gmail.com.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Bhandari
authors.affiliation: Public Health Research Laboratory, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal.
authors.forename: Jeevan Bahadur
authors.initials: JB
authors.lastname: Sherchand
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000469:parasitology; D000293:Adolescent; D000328:Adult; D000818:Animals; D016845:Blastocystis hominis / Q000302:isolation & purification / Q000502:physiology; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004748:Entamoeba histolytica / Q000302:isolation & purification / Q000502:physiology; D005243:Feces / Q000469:parasitology; D005260:Female; D016829:Giardia lamblia / Q000302:isolation & purification / Q000502:physiology; D015658:HIV Infections / Q000453:epidemiology*; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006790:Host-Parasite Interactions; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D010271:Parasites / Q000145:classification / Q000302:isolation & purification* / Q000502:physiology; D055815:Young Adult
keywords: CD4 T-cell; Diarrhea; Enteric parasites; HIV; Multi-parasitism