Intestinal parasitosis in relation to CD4 count and anemia among ART initiated patients in St. Mary Aksum general hospital, Tigray, Ethiopia

Unveiling the prevalence of anaemia and its predictors among adults on highly active antiretroviral therapy in the dolutegravir era: a retrospective cross-sectional study

OBJECTIVE

This study examined the prevalence, severity and risk factors of anaemia among adult people living with HIV attending an antiretroviral therapy centre in Woreta Primary Hospital, Woreta town, Ethiopia.

DESIGN

Hospital-based retrospective cross-sectional study.

SETTING

Public health facility that provides HIV care in Woreta town.

PARTICIPANTS

A total of 289 medical records of adults living with HIV/AIDS on highly active antiretroviral therapy from February 2019 to September 2023 at government hospital were reviewed using a systematic sampling method. The data were entered using Epi-info V.7 and exported to SPSS V.23 for data analysis. The data were analysed using bivariate and then multivariate logistic regression models in order to identify variables associated with anaemia. At the 95% CI level, variables having a p value of <0.05 were deemed to be statistically significant predictors.

PRIMARY OUTCOME

Prevalence and severity of anaemia and its predictors among adult patients living with HIV on antiretroviral therapy in Woreta Primary Hospital.

RESULTS

The total prevalence of anaemia was 31.5% (95% CI 28.9 to 33.8). The prevalence of mild, moderate and severe anaemia was 20.42%, 10.38% and 0.70%, respectively. Predictors independently linked with anaemia were female sex (adjusted OR (AOR) 1.08), age ≥40 years (AOR 1.21), lived with HIV >10 years (AOR 2.31), CD4 counts <200 cells/µL (AOR 3.81), non-suppressed viral load (AOR 1.28), history of opportunistic infections (AOR 1.54), WHO clinical stages III and IV (AOR 1.37 and 2.23, respectively) and history of parasitic infestation (AOR 2.81).

CONCLUSIONS

A sizeable proportion of participants were found anaemic. Female sex, older age, longer periods lived with the virus, lower CD4 count, non-suppressed viral load, history of opportunistic infections, WHO clinical stages III and IV and history of parasitic infestation were the contributing factors. Therefore, to improve the anaemic status and living circumstances of patients living with HIV, immediate action on the linked factors is needed, such as monitoring for maintenance of CD4 counts >200 cells/μL and avoiding progression of HIV to the advanced WHO clinical stages, suppressed viral load, preventing opportunistic infections and parasitic infestation.

National burden of intestinal parasitic infections and its determinants among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia: A systematic review and meta-analysis

Objectives:

The aim of this systematic review and meta-analysis is designed to assess the pooled prevalence and determine risk factors of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy in Ethiopia.

Methods:

International databases: PubMed, Web of Science, Cochrane Library, Scopus, PsycINFO, African Journals Online, and Google Scholar were systematically searched. Publication bias was determined using the funnel plot and Egger’s regression tests. Heterogeneity between the studies included in this review was checked by I² statistic. The DerSimonian and Laird random-effects model was applied to estimate the pooled effect size. Sub-group, meta-regression, and sensitivity analysis were conducted. Overall, meta-analysis was done using Stata version 14 statistical software.

Results:

Twenty-seven studies with 8946 individuals were included, the estimated pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS on anti-retroviral therapy was 40.24% (95% confidence interval = 33.8–46.6). Based on sub-group analysis, the highest prevalence was observed in the Tigray region 45.7% (95% confidence interval = 7.9–83.5), followed by Oromia region 42.2% (95% confidence interval = 28.8–55.6). Availability of latrine (odds ratio = 26.6, 95% confidence interval = 2.8–15.8), presence of animals at home (odds ratio = 2.7, 95% confidence interval = 1.2–5.8), and source of drinking water (odds ratio = 3.2, 95% confidence interval = 1.3–7.5) were significantly associated with intestinal parasitic infections.

Conclusion:

These findings indicated that the prevalence of intestinal parasites among people living with HIV/AIDS was high in Ethiopia.

Intestinal Parasitosis and its Association with CD4+ T Cell Count and Viral Load among People Living with HIV in Parasite Endemic Settings of Northwest Ethiopia

Purpose

To study intestinal parasitosis and its association with viral load and CD4+ T cell count in HIV-infected individuals at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Methods

A cross-sectional study was conducted from March to June 2019. Three hundred and sixteen study participants were selected using systematic random sampling technique. Sociodemographic and clinical data were collected using structured questionnaire. Stool samples were collected and examined using direct saline, formol ether concentration technique and modified acid fast staining. CD4+ T cell counts and viral load were determined by fluorescence-activated cell sorting (BD FACS) and COBAS Ampliprep/COBAS TaqMan HI2CAP assay, respectively. Data were entered into Epi Data 3.1 and transferred to SPSS version 20 software for analysis. Bivariable and multivariable analyses were performed using a binary logistic regression model. P values of less than 0.05 were considered statistically significant.

Results

The overall prevalence of intestinal parasitosis was 24.7% (78/316). The most commonly detected parasite was Cryptosporidium species with 5.4% (17/316), followed by Ascaris lumbricoides with 5.1% (16/316). There was a significant association with low CD4+ T cell count (AOR: 3.207; 95% CI: 1.237, 8.317), high viral load (AOR: 2.933; 95% CI: 1.326, 6.489), individuals aged 31–40 years (AOR: 0.305; 95% CI: 0.124, 0.751) and individuals aged 41–50 years (AOR: 0.261; 95% CI: 0.101, 0.671).

Conclusion

In this study, prevalence of intestinal parasitic infections was high and was associated with low CD4+ T cell count and high viral load. Therefore, screening of HIV patients, especially those with low CD4+ T-cell count and high viral load, particularly for opportunistic intestinal parasitic infections would be of utmost importance in the efforts to prevent and control opportunistic infections in HIV patients.

Global prevalence and associated risk factors of diarrheagenic Giardia duodenalis in HIV/AIDS patients: A systematic review and meta-analysis

Giardia duodenalis is one of the leading causes of diarrhea, mostly in underdeveloped nations of Africa and Asia. The present review provides insights into the prevalence, odds ratios (ORs) and associated risk factors of giardiasis in HIV/AIDS patients. Four major English databases (Web of Science, PubMed, Scopus, and Google Scholar) were excavated for relevant literature without time limitation until 20 November 2020. Next, meta-analysis was performed using a random-effects model and 95% confidence intervals (CIs). As well, heterogeneity among studies was evaluated using Cochran's Q and the I²-statistic. Totally, 19,218 HIV/AIDS patients in 130 studies were examined, showing a 5% (95% CI: 4.2%-6%) pooled prevalence. Also, the weighted random-effects OR of G. duodenalis infection among HIV/AIDS patients in comparison with their controls in 48 case-control studies was estimated as 1.71% (95% CI: 1.1%-2.66%, p = 0.016). Based on sensitivity analysis, there was no remarkable variation in the pooled OR upon omitting individual studies. Diarrhea was a potent risk factor, since HIV/AIDS patients with diarrhea were 3.8-times (95% CI: 1.6-8.9, p = 0.002) more prone to G. duodenalis infection than those without diarrhea. Moreover, the prevalence of the parasitic infection was 1.2-times higher in patients without antiretroviral therapy (ART) than those with ART (p = 0.312). Meta-regression was employed to evaluate the possible association between G. duodenalis frequency in HIV/AIDS patients and some variables such as sample size, publication year, and HDI. Additionally, the pooled prevalence of G. duodenalis infection was estimated based on several subgroups, including publication years, WHO regions, countries, continents, country incomes, and CD4⁺ T-cell levels. Altogether, the epidemiology of giardiasis in HIV/AIDS patients and its association with various risk factors is still open to question and requires more detailed and comprehensive investigations.

Prevalence, risk factors and impact of cellular immunity on intestinal parasitosis among people living with HIV at Auchi, Edo State, Nigeria

This study was sought to determine the impact of CD4⁺ T-cell count and associated risk factors with intestinal parasitosis in people living with HIV (PLHIV) in Central Hospital, Auchi, Edo State, Nigeria. One hundred and seventy (170) HIV-seropositive subjects were enrolled in the study from 24 August 2015 to 22 January 2016. Sociodemographic data were assessed using structured questionnaires. Blood and stool samples were collected from every participant. CD4⁺ T-cell count and stool parasitology were performed. The prevalence of intestinal parasites was 44.7%. Helminthiasis (67%) was a predominant infection in the study, while 32.9% had protozoasis. Specifically, Ancylostoma duodenale (33.3%) was the most common helminth, and Trichuris trichiura (7.8%), the least. However, Strongyloides stercoralis, Ascaris lumbricoides and Hymenolepis nana were 13.7%, 31.5% and 13.7%, respectively. Cryptosporidium spp. (25.0%) was the only protozoan. Lower CD4⁺ T-cell count, ART naivety (OR = 2.62 p < 0.05), residence in a rural setting (OR = 0.89, p < 0.05), and farming occupation (OR = 1.70, p < 0.05) were associated with the prevalence of intestinal parasitosis among PLHIV. This study revealed a significantly high prevalence of intestinal parasitosis in ART naive PLHIV with reduced CD4⁺ count. Hence, it is recommended to frequently test for intestinal parasitosis and commencement of ART in all PLHIV to improve their health and longevity.

Coinfection of HIV-1 with Schistosoma spp. and with Intestinal Parasites in Patients Attending Boane Health Center, Maputo Province, Mozambique

Background

It is hypothesized that schistosomiasis and intestinal parasites increase susceptibility to HIV-1 infection and enhance AIDS progression by immunomodulation. This study aims to compare the prevalence and risk factors for schistosomiasis and intestinal parasites in HIV-1 infected and uninfected persons and to evaluate the association between HIV-1 induced immunosuppression and risk factors for parasite infection.

Methods

This was a cross-sectional study conducted at Boane Health Center in Boane village, Maputo Province from April to June 2017 in 280 patients aged over 5 years. From each of 140 HIV-1 infected or 140 HIV-1 uninfected persons, demographic and clinical data were collected as well as one stool and urine sample for parasitological analysis. All stool samples were processed using direct wet mount and Ritchie method for detection of common parasites, and modified Ziehl-Neelsen staining techniques to identify Cryptosporidium spp., Cystoisospora belli and Cyclospora spp. oocysts from children stools. The urine was sedimented and analyzed for S. haematobium eggs detection.

Results

The overall prevalence of parasitism in the study population was 46.8% (131/280). Fifty six percent of the HIV-1 infected persons (78/140) were infected by at least one parasite compared to 38% (53/140 of the HIV-1 uninfected persons (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.2-3.3).Further, HIV-1 infected persons were more likely to be infected by S. mansoni (OR 5.6, 95% CI 1.8-15.8) when compared to HIV-1 uninfected person and HIV-1 infected women were more likely to be infected by S. mansoni (OR 6.7 CI 95% 1.8-22.8%) when compared to HIV-1 uninfected women (p< 0.001). HIV-1 serostatus (OR 7.0, 95% CI 1.5-31.2). Multivariate logistic regression revealed that HIV-1 infected status (OR=1.813575), the use of river or lake as water sources either for drinking (OR=7.289245) or domestic chores (OR=9.16205) were significant risk factor for parasitic infection. Partcipants with secondary and higher school (OR=0.379) were less likely to have a parasitic infection compared with primary school or illiterate participants.

Conclusions

It is possible that the a high prevalence of schistosomiais and intestinal parasites in this region plays an important role on the transmission and pathogenesis of HIV.

Predictors of intestinal parasite infection among HIV patients on antiretroviral therapy in Jos, Plateau State, Nigeria, 2016: a cross-sectional survey

Introduction

intestinal parasitic infection has been reported as a cause of morbidity and mortality among HIV patients on antiretroviral therapy (ART) due to interruption in treatment of the defaulting HIV patients. This study aimed to determine the prevalence and possible causes of intestinal parasites among HIV patients on ART.

Methods

a survey involving 375 adult HIV/AIDS patients selected using a systematic random sampling technique was conducted in a Jos University Teaching hospital, Plateau State, Nigeria. Socio-demographic and clinical data was collected using semi-structured interviewer administered questionnaire and electronic dataset review. Fresh stool samples were collected from all participants for laboratory identification of intestinal parasites using formol-ether sedimentation and modified Ziehl-Neelsen techniques. Descriptive statistics, odds ratio and logistic regression model were computed at P ≤ 0.05.

Results

the mean age of the study participants was 41.6±9.3years. Majority 294 (78.4%) were females, 141 (37.6%) lived in the rural area, 50 (13.3%) respondents did not have toilets in their homes. Most 275 (73.3%) had ART adherence level of 95% and above. Prevalence of intestinal parasites was 28.5%. Females (aOR = 2.14, 95% CI=1.12 – 3.89) and participants with no toilet facilities (aOR = 2.0, 95% CI=1.03 – 3.94) were significantly more likely to have intestinal parasites.

Conclusion

the prevalence of intestinal parasites was high among HIV patients. Gender and unavailability of toilet in homes were found to be predictors of having parasites. We recommend that HIV patients should be periodically screened for IPs during the follow-up clinic visits.

Intestinal parasitic infections and associated factors among people living with HIV/AIDS in Ethiopia: A systematic review and meta-analysis

Background

Intestinal parasitic infections are major public health problems throughout the world, particularly in people living with HIV/AIDS. People living with HIV/AIDS are vulnerable groups for a variety of diseases, hence they are easily affected by opportunistic and non-opportunistic intestinal parasites due to the weakening of their immunity. Therefore, this study aimed to estimate the pooled prevalence and factors associated with intestinal parasitic infections among people living with HIV/AIDS in Ethiopia.

Methods

Articles were identified through search engines in the online electronic databases PubMed/MEDLINE, EMBASE, HINARI, CINAHL, Cochrane Library, Google Scholar, and reference lists of previous studies following the PRISMA Protocol. Studies conducted between 2003 and 2020 with English language were included in this study. This review included papers with having high-quality NOS scores. Meta-analysis was computed using STATA version 11 software. Heterogeneity was assessed using the Cochrane Q-test and I² test statistics. Subgroup and sensitivity analysis was employed with evidence of heterogeneity. Publication bias was determined using the funnel plot and Egger’s regression test statistic.

Results

This study included a total of twenty-two cross-sectional studies with 5,833 study participants. The mean age of the study participants was 35 years old. The pooled prevalence of intestinal parasitic infection among people living with HIV/AIDS in Ethiopia was 39.15% (95%CI: 32.34, 45.95). The pooled prevalence of intestinal parasitic infections among people living with HIV/AIDS who had taking ART and who had not to start ART was found to be 28.27% (95%CI 22.47, 34.06) and 41.63% (95%CI: 28.75, 54.52) respectively. Unavailability of latrine (AOR: 4.87, (95% CI: 2.39, 9.92)), CD4+ T cell count <200cells/μl ((AOR: 3.53, (95%CI: 1.98, 6.27)), and having a history of diarrhea (AOR: 4.79 (95%CI: 1.53, 14.99) were factors significantly associated with intestinal parasitic infections.

Conclusion

In this study, the overall pooled prevalence of intestinal parasitic infections among HIV/AIDS patients in Ethiopia was relatively high. CD4+ T-cell count <200cells/μl, unavailability of a latrine, and history of diarrhea were significantly associated with intestinal parasitic infections. Therefore, the policymakers and health care professionals could give special attention to the presence of latrines, early detection and treatment of intestinal parasitic infections, and early initiation of ART drugs.

Prevalence of enteric bacteria and enteroparasites in human immunodeficiency virus-infected individuals with diarrhoea attending antiretroviral treatment clinic, Arba Minch General Hospital, southern Ethiopia

In Ethiopia, only limited data are available regarding the prevalence of enteric bacterial pathogens and enteroparasites in human immunodeficiency virus (HIV) -infected individuals with diarrhoea. Hence, this study aims to assess the prevalence of enteric bacteria and enteroparasites, and also the antibiotic susceptibility patterns of bacteria in them. An institution-based cross-sectional study was performed in HIV patients with diarrhoea, who visited the Anti-Retroviral Therapy Clinic of the Arba Minch General Hospital between 1 March and 31 August 2019. Data pertaining to sociodemographic characteristics and other factors were collected using a structured questionnaire. Stool culture is of utmost importance in the case of HIV-infected individuals with diarrhoea. Stool samples were collected and examined for bacterial and parasitic pathogens following standard procedures. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. Data were analysed using SPSS software. A total of 180 individuals were included in the stool collection process. The prevalence rates of enteric bacteria and enteroparasites were 8.3% and 36.1%, respectively. Parasitic infections were more frequent than bacterial infections in these HIV-infected individuals; commonly identified enteroparasites were Giardia lamblia (8.9%) and Cryptosporidium parvum (8.3%). Campylobacter sp. was the most predominant enteric bacterial isolate (4.4%), followed by Salmonella (2.1%) and Shigella (1.1%) species. CD4 counts <200 cells/μL was significantly associated with both bacterial infections (adjusted OR 9.55, 95% CI 1.54-59.3, p 0.015) and parasitic infections (adjusted OR 3.53, 95% CI 1.3-17.9, p 0.03). Multidrug resistance was also detected in 100%, 75% and 60% of Shigella, Campylobacter and Salmonella sp., respectively. We found that enteroparasitic infections were more frequent than bacterial infections. Statistical analysis revealed that CD4 T-cell counts <200 cells/μL, quality of drinking water sources, hand washing habits after toilet and the presence of domestic animals were significantly associated with the prevalence of enteric pathogens.

Intestinal Parasitic Infections among HIV-Infected Patients on Antiretroviral Therapy Attending Debretabor General Hospital, Northern Ethiopia: A Cross-Sectional Study

Background

Parasitic infections are known causes of morbidity among HIV-infected patients with low CD4⁺ counts who are on antiretroviral therapy (ART), mainly as a result of immuno suppression. This study aimed to assess the extent of intestinal parasitic infection and related risk factors among HIV-infected patients attending ART clinic at Debretabor General Hospital, Northern Ethiopia.

Methods

A health facility-based cross-sectional study was conducted on 383 HIV-infected patients attending the ART clinic of Debretabor General Hospital, northern Ethiopia from December 2018 to March 2019. An interview-based structured questionnaire was used to gather sociodemographic and risk-factor data. About 5 g fresh stool and 4 mL venous blood were collected from each patient, then transported and tested in accordance with laboratory-standard operating procedures. Data obtained were entered into SPSS version 22.0 and analyzed. P<0.05 with 95% CI was considered statistically significant.

Results

The overall prevalence of intestinal parasites was 25.3%, with 18% and 23.8% by direct wet-mount and formol ether-concentration technique, respectively. Eight (2.1%) patients were infected by multiple parasites using the concentration technique. Ascaris lumbricoides was the most frequently identified parasite (n=23, 25.3%). Parasitic infection was significantly higher among illiterates (P=0.011), patients with CD4 count <200 cells/mm³ (P<0.001), and those who did not have a toilet in their home (P=0.049) than their counterparts.

Conclusion

Relatively higher prevalence of intestinal parasitic infection was found among HIV/AIDS patients. The distribution of intestinal parasites was greatly affected by illiteracy, reduced CD4⁺ counts, and absence of a toilet. Therefore, HIV/AIDS patients with low CD4⁺ counts should be diagnosed consistently for intestinal parasites with routine stool examinations, and awareness creation should be advocated to be included as an essential component of ART-monitoring strategies for improved patient care.

Cryptosporidium infection among people living with HIV/AIDS in Ethiopia: a systematic review and meta-analysis

Studies on the prevalence of Cryptosporidium infection in People Living with HIV/AIDS (PLWHA) are inconsistent and heterogeneous. Therefore, this systematic review with meta-analysis was performed to assess the burden of the infection relative to the proportion of CD4 + T cell count among PLWHA in Ethiopia. Articles published before 15 May 2019, have been retrieved for this systematic review using five databases; PubMed, Scopus, Web of Science, Google Scholar and ProQuest, supplemented by the search for gray literature. The overall pooled prevalence and pooled Odds Ratio (OR) with their 95% Confidence Intervals (CI) were estimated using STATA 14 statistical Software. Of the 255 studies retrieved, 31 were considered for the final analysis. As many as 8,645 Ethiopians infected with HIV were included in the final quantitative synthesis. The overall pooled prevalence estimate of Cryptosporidium infection among PLWHA in Ethiopia was 11% (95%CI: 0.09-0.13). HIV-infected people with low CD4 + T cell count (CD4 < 200 cells/mm3) were 13.07 times more likely to become infected with Cryptosporidium than those with high CD4 + T cell count (CD4 > 500 cells/mm3) (OR: 13.07 (95%CI: 6.38-26.75). Cryptosporidium infection in PLWHA in Ethiopia showed decreasing patterns in 2001-2010, 2011-2014, and in 2015-2019, 14.6% (95%CI: 0.076-0.217), 12.71% (95%CI: 0.086-0.167) and 6.7% (95%CI: 0.044-0.090), respectively (p < 0.001). Though the pattern of Cryptosporidium infection in HIV-infected Ethiopians showed a declining trend; it remains a considerable problem that requires improvement in routine screening for Cryptosporidium in HIV-infected people, particularly with poor or declining CD4 + T cell count.