title: Occurrence of enteric parasitic infections among HIV-infected individuals and its relation to CD4 T-cell counts with a special emphasis on coccidian parasites at a tertiary care centre in South India.
abstract: BACKGROUND
  Diarrhoea is one of the major complications occurring in over 90% of HIV-infected individuals in developing countries. Coccidian group of parasites, being opportunistic pathogens, have been implicated as the most common causative agents of diarrhoea among HIV-infected population.
  
  
  OBJECTIVE
  The aim was to study the magnitude of parasitic diarrhoea with special context to coccidian parasitic infections in HIV-infected individuals and their association with the patient's immunological status measured by CD4 T-cell counts.
  
  
  METHODS
  This investigation was performed between January 2002 and December 2014 at a tertiary HIV care centre in Chennai, South India.
  
  
  METHODS
  Stool samples were collected and microscopically observed for parasites using direct, formal-ether-concentrated wet mounts and modified acid-fast staining for coccidian parasites. CD4 T-cell counts were done by FACScount.
  
  
  METHODS
  All statistical analyses were performed using GraphPad Prism software, version 5.0, andP < 0.05 was considered statistically significant.
  
  
  RESULTS
  Coccidian parasitic infection accounted for about 23.4% of parasitic infections, and of these, Cystoisospora belli was observed to be the most common cause of diarrhoea (88.8%), followed by Cryptosporidium spp. (9.9%) and Cyclospora spp. (1.3%). Trend analysis of coccidian aetiology during the study period revealed a significant rise in the positivity of C. belli and Cryptosporidium spp. (P = 0.001). Among the HIV patients with CD4+ T-cell counts <200 cells/μL, Cryptosporidium infection was most common (90%), followed by infection with C. belli(61.4%).
  
  
  CONCLUSIONS
  Coccidian parasites continue to be the most common aetiological agent of diarrhoea among patients with HIV. The increasing trend of positivity of both cystoisosporiasis and cryptosporidiosis over the study period and the high positivity of cryptosporidiosis in patients with lower CD4+ T-cell counts are issues of serious concern. The findings call for the need for the early diagnosis of coccidian parasites and appropriate intervention among HIV-infected patients.
authors.affiliation: Infectious Diseases Laboratory, Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
authors.forename: Chinnambedu R
authors.initials: CR
authors.lastname: Swathirajan
authors.affiliation: Infectious Diseases Laboratory, Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India; Laboratory-based Department, Universiti Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia.
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Vignesh
authors.affiliation: Medical Centre, Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
authors.forename: Ambrose
authors.initials: A
authors.lastname: Pradeep
authors.affiliation: Medical Centre, Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India; Department of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, USA.
authors.forename: Sunil S
authors.initials: SS
authors.lastname: Solomon
authors.affiliation: Infectious Diseases Laboratory, Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Infectious Diseases Laboratory, Y. R. Gaitonde Centre for AIDS Research and Education, Chennai, Tamil Nadu, India.
authors.forename: Pachamuthu
authors.initials: P
authors.lastname: Balakrishnan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000469:parasitology; D000328:Adult; D000818:Animals; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D003044:Coccidia / Q000145:classification / Q000302:isolation & purification*; D003048:Coccidiosis / Q000453:epidemiology* / Q000469:parasitology; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D005243:Feces / Q000469:parasitology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000276:immunology*; D006801:Humans; D007194:India / Q000453:epidemiology; D007411:Intestinal Diseases, Parasitic / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008853:Microscopy; D010274:Parasitology; D015995:Prevalence; D062606:Tertiary Care Centers