Prevalence of Cryptosporidium parvum in AIDS and immunocompetent patients in Uganda

Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa

Understanding the natural history of human immunodeficiency virus type 1 (HIV-1) and opportunistic infections in sub-Saharan Africa is necessary to optimize strategies for the prophylaxis and treatment of opportunistic infections and to understand the likely impact of antiretroviral therapy. We undertook a systematic review of the literature on HIV-1 infection in sub-Saharan Africa to assess data from recent cohorts and selected cross-sectional studies to delineate rates of opportunistic infections, associated CD4 cell counts, and associated mortality. We searched the MEDLINE database and the Cochrane Database of Systematic Reviews and Cochrane Clinical Trials Register for English-language literature published from 1990 through April 2002. Tuberculosis, bacterial infections, and malaria were identified as the leading causes of HIV-related morbidity across sub-Saharan Africa. Of the few studies that reported CD4 cell counts, the range of cell counts at the time of diagnosis of opportunistic infections was wide. Policies regarding the type and timing of opportunistic infection prophylaxis may be region specific and urgently require further study.

Agents of diarrhea

Diarrhea is a common problem for AIDS patients, and is chronic and debilitating. A thorough evaluation will reveal a pathogen in the majority of patients, and the organisms most frequently identified in AIDS patients with chronic diarrhea are Cryptosporidium, microsporidia, and Mycobacterium avium complex. Bacterial pathogens are more common in AIDS patients than in the general population and may present in different ways from infections in immunocompetent hosts. Other pathogens, including Cryptosporidium and microsporidia, are difficult to diagnose and have no effective therapy. Moreover, enteric viruses and HIV itself may contribute to the diarrhea. In addition to microbes, other factors such as medication, immune dysregulation, automatic dysfunction, and nutritional supplementation play a substantial role in diarrhea of AIDS patients.