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

Prevalence of intestinal parasites and associated factors among patients with HIV/AIDS at the anti-retroviral treatment clinic of Mizan-Tepi University Teaching Hospital, Southwest Ethiopia

Background

Intestinal parasitic infections remain very common, particularly in areas with a high prevalence of immune-compromised patients, such as HIV/AIDS patients. The purpose of this study was to determine the prevalence of intestinal parasites and associated factors in people living with HIV/AIDS at an ART clinic in Mizan-Tepi University Teaching Hospital, southwest Ethiopia.

Method

A cross-sectional survey was conducted from July to September 2021. A total of 191 adult people living with HIV/AIDS participated in this study. Data on socio-demographic, clinical, and other risk factors were collected using a structured questionnaire. Stool samples were collected and processed using a direct wet mount, formol-ether concentration, and modified Ziehl-Nelson staining techniques. The data were analyzed using the Statistical Package for Social Sciences Version 25 software.

Results

Among 67 adult individuals living with HIV/AIDS, the prevalence of intestinal parasites was 35.1%. Specifically, 31.5% (45/143) of patients on antiretroviral therapy (ART) and 45.8% (22/48) of ART-naïve patients were infected. The distribution of intestinal parasites was as follows: protozoa were found in 14.7% of ART-treated patients and 22.9% of ART-naïve patients; helminths in 15.4% of ART-treated patients and 16.7% of ART-naïve patients; and opportunistic parasites in 1.4% of ART-treated patients and 6.25% of ART-naïve patients. Significant associations with a higher prevalence of intestinal parasites were observed for a CD4 count <200 cells/mm3 (Adjusted Odds Ratio [AOR] = 3.77; 95% Confidence Interval [CI]: 1.01-13.15; p = 0.04), consumption of unwashed raw vegetables (AOR = 3.29; 95% CI: 1.23-8.86; p = 0.02), and residing in rural areas (AOR = 2.34; 95% CI: 1.27-4.32; p = 0.01).

Conclusion

The findings indicate that a significant proportion of adults living with HIV/AIDS are affected by intestinal parasites, with a notably higher prevalence among ART-naïve patients compared to those on ART. Factors such as a low CD4 count, consumption of unwashed raw vegetables, and rural residence are associated with increased risk of intestinal parasite infections. These results underscore the importance of improving hygiene practices and access to healthcare, particularly in rural areas, to reduce the burden of parasitic infections among individuals living with HIV/AIDS.

Magnitude of intestinal parasitic infections and its determinants among HIV/AIDS patients attending at antiretroviral treatment centers in East and West Gojam Zones, Northwest, Ethiopia: institution based cross-sectional study

BACKGROUND

Intestinal parasitic infections (IP) are a major source of morbidity in people living with Human immunodeficiency virus (HIV), particularly in resource-limited settings, mostly as a result of high viral load. Hence, this study aimed to investigate the magnitude of intestinal parasitic infections and its determinants among patients with HIV/AIDS attending public health facilities in East and West Gojam Zones in Ethiopia.

METHODS

Institution-based cross-sectional study was conducted on 327 people living with HIV visiting public health facilities from December 2022 to May 2023. A simple random sampling technique was used to recruit participants. Face-to-face interviews were used to collect socio-demographics and determinants. The fresh stool was collected from each patient, transported, and tested in accordance with laboratory standard operating procedures of wet mount, formol-ether concentration technique, and modified acid-fast staining. Data were entered and analyzed in the statistical package for Social Science (SPSS) version 20. A 95% CI with p-value < 0.05 was considered statistically significant.

RESULTS

The overall prevalence of IP in patients with HIV/AIDS was 19.3% (63/327). Hookworm was the most identified parasite 33.3% (21/63) followed by E.histolytica 17% (11/63) and G.lamblia 14.3% (9/63). Parasitic infections were significantly higher among viral load > 1000cps/ml (p = 0.035), WHO stage 4 (p = 0.002), CD4 < 200 cell/mm3 (p = 0.001), and bare foot walking (p = 0.001).

CONCLUSION

IP infections are moderately high among patients with HIV/AIDS in the study area. The proportion of parasites was greatly affected by high viral load, WHO stage 4, CD4 < 200 cell/mm3, and being barefoot; this gives valuable insight to health professionals, health planners and community health workers. As a result, viral load monitoring, and WHO stage controlling were periodically assessed in patients with HIV/AIDS. Health education, awareness creation, routine stool examination, and environmental hygiene were regularly advocated to increase the life of patients with HIV/AIDS.

Prevalence of soil-transmitted helminth infections in HIV patients: a systematic review and meta-analysis

Soil-transmitted Helminth (STH) infections have been found associated with people living with human immunodeficiency virus (HIV) but little is known about the overall burden of STH coinfection in HIV patients. We aimed to assess the burden of STH infections among HIV patients. Relevant databases were systematically searched for studies reporting the prevalence of soil-transmitted helminthic pathogens in HIV patients. Pooled estimates of each helminthic infection were calculated. The odds ratio was also determined as a measure of the association between STH infection and the HIV status of the patients. Sixty-one studies were finally included in the meta-analysis, consisting of 16,203 human subjects from all over the world. The prevalence of Ascaris lumbricoides infection in HIV patients was found to be 8% (95% CI 0.06, 0.09), the prevalence of Trichuris trichiura infection in HIV patients was found to be 5% (95% CI 0.04, 0.06), the prevalence of hookworm infection in HIV patients was found to be 5% (95% CI 0.04, 0.06), and prevalence of Strongyloides stercoralis infection in HIV patients was found to be 5% (95% CI 0.04, 0.05). Countries from Sub-Saharan Africa, Latin America & Caribbean and Asia were identified with the highest burden of STH-HIV coinfection. Our analysis indicated that people living with HIV have a higher chance of developing Strongyloides stercoralis infections and decreased odds of developing hookworm infections. Our findings suggest a moderate level of prevalence of STH infections among people living with HIV. The endemicity of STH infections and HIV status both are partially responsible for the burden of STH-HIV coinfections.

Assessment of intestinal parasites and associated factors among HIV/AIDS patients on antiretroviral therapy at Bule Hora General Hospital, West Guji, Ethiopia

Objective:

The study aimed to assess the prevalence of intestinal parasites and associated factors among people living with HIV/AIDS on antiretroviral therapy at Bule Hora General Hospital, West Guji, Oromia, Ethiopia.

Introduction:

Parasitic infection of the intestinal tract is a major source of disease in patients with HIV, particularly in the tropics, where diarrhea is a common complaint with variable severity.

Method:

An institution-based cross-sectional study was conducted from May to August 2021 on 179 systematic randomly selected HIV patients. Data on sociodemographics were collected by interviewing the study subjects using a pretested structured questionnaire. Stool specimens were collected from the study subjects and processed and examined by formol-ether concentration techniques. Data were obtained from each individual using data sheets and then entered into SPSS version 20 for analysis. The chi-square test was calculated, and a p value <0.05 was considered statistically significant.

Results:

Out of 179 study subjects, 52 (29.1%) were infected with intestinal parasites. The most frequently detected parasites were Giardia lamblia (38.5%) and Ascaris lumbricoides (25%) Entamoeba histolytica/dispar (15.4%), followed by Strongyloides stercoralis (11.5%). Factors such as the CD4+ T-cell status and source of drinking water were significantly associated with the prevalence of intestinal parasites among HIV/AIDS patients. The prevalence of intestinal parasites was highly observed among patients who scored CD4+ T cells <200 cells/mm³ 90.4% (47/52) and drink ground water 73.1% (38/52).

Conclusion:

There was moderate prevalence of intestinal parasites among HIV/AIDS patients; therefore, treating unprotected water before drinking and diagnosis of early parasites for HIV/AIDS patients whose CD4+ T-cell count is less than 200 cells/mm³ should be practiced to prevent intestinal parasite infection.

Intestinal Parasitic Infection and Associated Risk Factors among HIV-Infected Patients Seeking Healthcare in a Rural Hospital in Ghana

Background

Parasitic infections among human immunodeficiency virus (HIV)-infected patients are common in various regions and populations across the world and have since remained a persistent public health challenge. Sub-Saharan Africa harbors the greatest burden of the infections due to sociodemographic and behavioral factors. However, the prevalence of gastrointestinal parasitic infections among HIV-infected persons has been poorly investigated in Ghana.

Aim

This study sought to determine the prevalence of gastrointestinal parasitic infections and associated factors in HIV-infected individuals attending the antiretroviral therapy (ART) clinic in St. Mary Theresa Hospital, Dodi Papase.

Methods

A cross-sectional study was conducted from June 2021 to September 2021 among three hundred and thirty-five HIV-infected individuals in the study area. Sociodemographic and behavioral factors were collected with the aid of a close-ended structured questionnaire. Furthermore, stool samples were collected from each participant and examined for the presence of intestinal parasites by microscopy using direct wet mount, formol-ether concentration, and modified Ziehl–Neelsen (Zn) techniques. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0 and Graphpad Prism version 8.

Results

The prevalence of gastrointestinal parasitic infections was 5.97%. Species-specific prevalence was found to be 2.99% for Giardia lamblia, 1.19% for Ascaris lumbricoides, and 0.90% each for Entamoeba histolytica/dispar and Trichuris trichiura. There was a significant association between participants' educational level and intestinal parasitic infection. In addition, gastrointestinal parasitic infections were not found to be associated with age. Unemployed participants, those with a lower frequency of deworming, and those who do not use water closet toilet facilities were at a higher risk of getting infected.

Conclusion

The lower infection rate recorded in this study suggests that public health interventions put in place are yielding significant results. Even though the prevalence is low, routine screening of all HIV-infected patients for parasitic infection is recommended to ensure timely, effective treatment and comprehensive care.

Prevalence and Predisposing Factors of Intestinal Parasitic Infections Among HIV Positive Patients Visiting Nekemte Specialized Hospital, Western Ethiopia

Background

Intestinal parasites are endemic in many regions of the world where Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome (HIV/AIDS) patients are prevalent. This study aimed to assess the extent of intestinal parasitic infection (IPI) and predisposing factors among HIV positive patients visiting Nekemte Specialized Hospital, Western Ethiopia.

Methods

A hospital-based cross-sectional study was conducted among HIV positive patients and HIV negative controls who visited Nekemte Specialized Hospital from April to August 2020. A structured questionnaire was used to collect socio-demographic and risk-factor data. Stool samples and blood were collected and tested. Data were analyzed using SPSS version 20. P<0.05 was considered statistically significant.

Results

The occurrence of IPIs was considerably higher (73.3%) among HIV positive subjects compared to HIV negative controls (22.7%). Rate of infection with IPI was higher in individuals with CD4+ T cell count < 200 cells/μL. The species-specific distribution of parasites among HIV positive was higher for Giardia lamblia 35% followed by Entamoeba histolytica, 16% and hookworm 17.5%. Among the risk factors; age, educational status and occupation were significantly related with IPI (P<0.05). Habit of washing hands (OR=1.146, 95% CI: 0.189–1.936) and contact with animals (OR=2.926, 95% CI: 1.955–4.380) were expressively associated with IPI. Furthermore, eating raw meat, lack of safe water sources and usage were meaningfully connected with IPIs with OR=1.203, 95% CI: 0.590–2.454 and OR=0.172, 95% CI: 0.112–0.263, respectively.

Conclusion

HIV positive individuals were highly affected by IPI than HIV negative controls. The spreading of intestinal parasites was critically affected by reduced CD4+ T cell counts. Consistent screening and treatment of IPIs and awareness creation is very vital in improving the overall quality life of HIV/AIDS patients.

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.