Prevalence and Risk Factors of Intestinal Parasite Infestations in HIV-Positive Patients: A Cross-section Study in a Tertiary Care Center

Introduction: In many parts of the world where HIV/AIDS (human immunodeficiency virus) is common, the prevalence of intestinal parasitic infection is also common. Infections caused by intestinal parasites are one of the leading causes of morbidity and mortality in underdeveloped countries. The number of HIV-positive individuals increases annually as a result of more advanced infections and the positive effects of highly active antiretroviral therapy (HAART). Gastrointestinal involvement is common, with 90% of patients seeking treatment for gastrointestinal problems as their HIV infection progresses. Nonetheless, identification and characterization of infectious agents are important for patient management by excluding a clinical diagnosis and determining appropriate treatment, as well as determining public healthcare policy for true pathogen prevalence and yielding epidemiological risk factors for specific infections.

Aim: The aim of this study is to evaluate the prevalence of symptomatic or asymptomatic intestinal parasitic infection among HIV or AIDS patients.

Materials and Methods: For this study, 80 HIV seropositive patients were recruited from various wards and the Integrated Counseling and Testing Center (ICTC) affiliated to the microbiology department. Patients with acute and chronic diarrhea with abdominal disorder were taken as symptomatic whereas patients without these clinical complaints and who came for routine investigations were taken as asymptomatic. Firstly stool samples were analyzed macroscopically for the presence of mucus, blood, larvae, segments of tapeworm and adult worms. The consistencies of stool were also recorded such as formed, watery, soft, or loose with odor and color. It was examined microscopically after macroscopically for protozoan cysts and trophozoites, helminthic ova and larvae, as wet mount preparation by saline and iodine preparation as well as formal ether concentrated. For the detection of intestinal coccidian parasites, smears were prepared from stool samples and a modified Ziel-Nelseen (MZN) stain was also performed. Stool samples with the detection of parasites were informed for treatment.

Results: Out of the total 80 stool samples, the prevalence of intestinal parasites was 23.75% with asymptomatic and symptomatic groups having a prevalence of 16.98% and 37.04% respectively. Out of the total patients, 45 were male and 35 were female. Among the male patients, 11(13.75%) were positive for intestinal parasitic infection and 8(10%) were positive among females. The age distribution data revealed that the age group 21-40 years old had the highest number of intestinal parasites. Most intestinal parasites were found in young and middle-aged patients, according to this study. The patient with HIV-positive with CD4+ T cell count <200 cells/
l had a higher possibility of infestation with intestinal parasitic as compared to those with CD4+ T cell count of 200–499 and those with CD4+ T cell count >500 cells/
l.

Conclusion: Intestinal parasitic infection is not uncommon in HIV seropositive patients. This study underscores the need for early diagnosis and treatment of these intestinal parasites in both symptomatic and asymptomatic HIV patients. The overall improvement of HIV/AIDS patients' quality of life is highly dependent on routine intestinal parasite infection screening and treatment. However, to improve the management of infection in the affected areas, deworming and good hygiene measures are required.