Plasmodium falciparum and intestinal parasitic co-infections in HIV-infected patients in Benin City, Edo State, Nigeria
14 May 2012-Journal of Infection in Developing Countries (J Infect Dev Ctries)-Vol. 6, Iss: 5, pp 430-435
TL;DR: Evidence of co-infections between Plasmodium falciparum and intestinal parasites in HIV and intestinal parasitic infections is provided as this will enhance better management of HIV-infected patients.
Abstract: Introduction: Human co-infection with Plasmodium falciparum and helminthes is ubiquitous throughout Africa. This study aimed to determine the co-infections of Plasmodium falciparum infection in HIV and intestinal parasitic infections, and their immunological distribution, in Benin City, Nigeria. Methodology: A total of 2,000 stool specimens from HIV-positive patients and 500 controls (HIV-negative individuals) were examined for ova, cysts, or parasites using standard procedures. In addition, patients' blood samples were analyzed for CD4 counts by flow cytometry and examined for Plasmodium falciparum by microscopy. Results: The prevalence of single parasitic infection among HIV patients was 18.1% in males and 16.9% among females with no significant difference (p = 0.536) while gender was a risk factor in multiple parasitic infections (male versus female: 4.2% and 1.8% OR = 2.384; 95% CI = 1.371, 4.147) (p = 0.0025). Increasing age was not associated with increased risk of both single and multiple parasitic infections (p = 0.083; p = 0.248). CD4 + T cell count less than 200 cells/µl was a risk factor for acquiring single and multiple parasitic infections among HIV patients (OR = 5.565; 95% CI = 4.136, 7.486; p = 0.0001; OR = 4.283; 95% CI = 2.424, 7.566; p = 0.0001). The most common co-infection observed was between Plasmodium falciparum and Ascaris lumbricoides 43% (10) among HIV patients. Conclusion: This study provides evidence of co-infections between Plasmodium falciparum and intestinal parasites. Diagnosis of parasitic infections among HIV patients is advocated as this will enhance better management of HIV-infected patients.
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TL;DR: Cryptosporidium prevailed in HIV-positive patients with diarrhea, and interestingly, polyparasitic infections were demonstrated in chronic cases with a low CD4 count, therefore, regular antienteric parasitic prophylactic trials are recommended in for patients with lowCD4 cell count.
14 citations
TL;DR: The results suggest that other factors are involved in this complex interaction between HIV and malaria, and that Plasmodium falciparum is the only species infecting patients on anti-malarial and anti-retroviral drugs.
Abstract: The Human immunodeficiency virus (HIV) and malaria are two of the world’s most formidable pathogens. Coinfection has been shown to amplify the effects of both diseases with HIV infection enhancing the severity of malaria. Previous work in our laboratory has shown that individuals infected with malaria and HIV who are taking anti-retrovirals have the Plasmodium parasite in their bloodstream suggesting that the lack of anti-malarials in their drug regimen resulted in Plasmodium infection. In this study, we set out to determine the status of Plasmodium infection in a cohort of patients taking both anti-malarial and anti-retroviral drugs. Blood samples were collected from patients of the Edo district of Nigeria in Benin City co-infected with Plasmodium and HIV. We have found that 31 out of the 317 (9.78%) HIV patients on HAART and ACT had Plasmodium in their blood based on microscopic counts. Surprisingly, using the polymerase chain reaction (PCR), the prevalence was at 25.6% for Plasmodium. In addition, we have identified by PCR that Plasmodium falciparum is the only species infecting these patients. Furthermore, no significant relationship was found to exist between CD4+ T-cell counts and malarial infections (CD4 count<200 cells/µL (7.20%)) nor was the malaria parasite density significantly associated with CD4 count<200 cells/µL (P=0.595) in this study population in Benin City, Nigeria. These results suggest that other factors are involved in this complex interaction.
8 citations
Cites background from "Plasmodium falciparum and intestina..."
...In this study, we surveyed HIV and falciparum malaria co-infections, in Benin City, Nigeria, among patients prescribed with HAART (zidovudine, stavudine, and nevirapine) and ACT (artesunate-lumenfantrine combination) medications....
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...The teaching hospital is a tertiary health institution with a referral status serving 5 States of the Nigerian Federation: Edo, Delta, Ondo, *Corresponding author: Johanna Porter-Kelley, Department of Life Sciences, Winston-Salem State University, 601 Martin Luther King Dr. Winston Salem, NC 27110, USA, Tel: 336-750-3239; E-mail: porterkelleyj@wssu.edu Received July 20, 2013; Accepted September 09, 2013; Published October 16, 2013 Citation: Akinbo FO, Omoregie R, Dixon L, Brown K, Wilson R, et al. (2013) CoEndemicity of Plasmodium falciparum and HIV-Infections in Treated Patients is Uncorrelated in Benin City, Nigeria....
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...%)) nor was the malaria parasite density significantly associated with CD4 count<200 cells/µL (P=0.595) in this study population in Benin City, Nigeria....
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...falciparum and Ascaris lumbricoides in HIV-infected patients in Benin City, Nigeria [22]....
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...In previous surveys of HIV and malaria co-infections in Benin City, Nigeria, patients prescribed with HAART and ACT were excluded and a higher Plasmodium infection rate was observed in HIVinfected individuals [14]....
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TL;DR: Although haemoglobin levels increased overall for patients on zidovudine-containing regimens, for those in the 10th and 90th percentiles haem oxygen levels trended downward over time, these results have implications for decisions regarding when to initiate, switch from or avoid the use of zidvudine.
Abstract: We conducted a study to assess trends in haemoglobin recovery among HIV-infected patients initiated on zidovudine-based combination antiretroviral therapy (cART) stratified by baseline haemoglobin level. Haemoglobin data from non-pregnant adult patients initiating cART in rural north-central Nigeria between June 2009 and May 2011 were analysed using a linear mixed effects model to assess the interaction between time, zidovudine-containing regimen and baseline haemoglobin level on the outcome of subsequent haemoglobin level. Best-fit curves were created for baseline haemoglobin in the 10th, 25th, 75th and 90th percentiles. We included 313 patients with 736 measures of haemoglobin in the analysis (239 on zidovudine and 74 on non-zidovudine-containing regimens). Median haemoglobin increased over time in both groups, with differences in haemoglobin response over time related to baseline haemoglobin levels and zidovudine use (p = 0.003). The groups of patients on zidovudine at the 10th and 90th percentiles had downward sloping curves while all other groups had upward trending haemoglobin levels. Although haemoglobin levels increased overall for patients on zidovudine-containing regimens, for those in the 10th and 90th percentiles haemoglobin levels trended downward over time. These results have implications for decisions regarding when to initiate, switch from or avoid the use of zidovudine.
8 citations
TL;DR: The source of water, type of toilet and presence of diarrhoea significantly affected the prevalence of intestinal parasitic infections among artisans, and A. lumbricoides was the most prevalent parasitic agent recovered in this study.
Abstract: Context: Human intestinal parasites have always been a major health problem in the developing countries. This study was aimed at determining the prevalence of intestinal parasitic infections among artisans and establishes a relationship between the prevalence of intestinal parasitic infections and risk-factors. Materials and Methods: A total of 353 participants which consisted of 272 males and 81 females were recruited for this study with age ranging from 18 to 65 years. Stool specimens were collected from the participants and analysed using the standard technique. The data obtained were analysed using Chi-square (χ2 ) to compare the frequency data while the odd ratio was calculated for potential risk factors. Results: Out of 353 subjects, 118 (33.4%) subjects had intestinal parasitic infections. Age, gender, marital status, occupation, educational status and source of food did not significantly affect (P = 0.219, P = 0.920, P = 0.276, P = 0.087, P = 0.074 and P = 0.442, respectively) the prevalence of intestinal parasitic infections. The use of well/rain water (odds ratio [OR] =2.721; 95% confidence interval [CI] = 1.452, 5.100; P = 0.002) and presence of diarrhoea (OR = 6.169; 95% CI = 3.665, 10.474; P < 0.0001) were significantly associated with intestinal parasitic infections among artisans. Defecating in nearby bushes resulted in a significantly increased prevalence of intestinal parasitic infections among artisans (P < 0.0001). The intestinal parasites recovered were Ascaris lumbricoides, hookworm, Trichuris trichiura and Entamoeba histolytica. A. lumbricoides had the highest prevalence (77.8%). The male gender had the highest prevalence in all the four intestinal parasites recovered in this study. Conclusion: Overall prevalence of 34.4% of intestinal parasitic infections was observed among artisans in Benin City. The source of water, type of toilet and presence of diarrhoea significantly affected the prevalence of intestinal parasitic infections among artisans. A. lumbricoides was the most prevalent parasitic agent recovered in this study.
6 citations
01 Jan 2015
TL;DR: The human immunodeficiency virus (HIV) infection has continued to pose a lot of challenges to global health and it is posited that the prevalence of these parasites has more to do with sanitary status and living conditions than immune status.
Abstract: The human immunodeficiency virus (HIV) infection has continued to pose a lot of challenges to global health. About 4.5 million infected people live in Nigeria (Tyodugh et al., 2012). The infection is known to have altered both epidemiology and outcome of opportunistic parasiticinfections hitherto known as one of the most significant causes of illness in developing countries (Tian et al., 2012). Parasitic infections reported as the hallmark of AIDS (Ramakrishnan et al., 2007) have also been reported to have no significant difference in prevalence between HIV positive and HIV negative individuals (Berenji et al., 2012; Yosefi et al., 2012). In fact, Poka and associates posited that the prevalence of these parasites has more to do with sanitary status and living conditions than immune status (Poka et al., 2012). ISSN: 2319-7706 Volume 4 Number 4 (2015) pp. 768-776 http://www.ijcmas.com
1 citations
Cites result from "Plasmodium falciparum and intestina..."
...This agrees with findings by Akinbo and coworkers in Benin city (Akinbo et al., 2012) but is in contrast to reports by Ekejindu et al. (2011) in Nigeria, Asmaet al. (2011) in Malaysia and Ramakrishnan (2007) in India....
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...This agrees with findings by Akinbo and coworkers in Benin city (Akinbo et al., 2012) but is in contrast to reports by Ekejindu et al....
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References
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Journal Article•
TL;DR: The findings reflect the importance of evaluating the prevalence of intestinal parasites in HIV-positive/AIDS patients especially at the local level where antiretroviral therapy is not available and provide vital information for health professionals who are managing these patients.
Abstract: The aim of this study was to assess the prevalence of intestinal parasites among HIV-positive/AIDS patients. A control group comprising 30 apparently healthy HIV-negative individuals was included. Of the 60 samples collected from the patients and examined, 34 (56.7%) presented with diarrhoea, while 26 (43.3%) had no reported cases of diarrhoea at the time of study. Seventeen (50%) of the parasites detected in the 34 patients (those with history of diarrhoea) were diarrhoea-related causative agents. However, 17 (50%) of the parasites detected were not diarrhoea-related causative agents. In relation to diarrhoea, Cryptosporidium parvum had the highest prevalence (10%), followed by Giardia intestinalis (8.3%), Entamoeba histolytica (6.7%), Isospora belli (3.3%) and Blastocystis hominis (3.3%) in that order. This study showed a significant prevalence (P<0.05) of intestinal parasites in HIV-positive/AIDS patient. Also, the prevalence of intestinal parasites was higher (P<0.05) in HIV-positive/AIDS patients than in HIV-negative subjects. Although the study is limited in scope, however, it does reflect the importance of evaluating the prevalence of intestinal parasites in HIV-positive/AIDS patients especially at the local level where antiretroviral therapy is not available. The results of this study thus provide vital information for health professionals who are managing these patients. This could lead to improvement in patients' management and care.
28 citations
"Plasmodium falciparum and intestina..." refers result in this paper
...This finding is consistent with those of previous reports [1,12,15,16,17]....
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Journal Article•
TL;DR: PCV might be of useful indicator and if not monitored could lead to AIDS establishment especially where high malaria parasitaemia is noted, and malaria coinfection may moderate the impact of HIV infection on PCV.
Abstract: Background & objectives: The study was designed: (i) to determine the prevalence of malaria parasites; (ii) to determine the relationship between parasitaemia and age/sex; (iii) to correlate the PCV levels with parasitaemia; and (iv) to determine the influence of protection against natural transmission on the prevalence of malaria. Methods: Participants were recruited at the Plateau State Human Virology Research Laboratory (PLASVIREC), Robert Gallo House at the Plateau State Specialist Hospital, Jos and grouped into: (i) Malaria and HIV co-infection group (n = 64); and (ii) HIV infected group without concurrent malaria infection (n = 136). Standard laboratory procedures were used for the HIV and Plasmodium parasites screening, malaria parasite density, and packed cell volume. Results: The results showed a significant difference (p <0.05) among the sexes and age groups. About 64 (32%) of the individuals had Plasmodium infection (30% Plasmodium falciparum, 0.5% P. malariae, and 1.5% mixed infections of P. falciparum and P. malariae). Malaria parasites were more common among the rural dwellers and in the age group of 21–30 yr. Regression analysis showed a negative association of malaria parasitaemia and PCV among the malaria–HIV positive and malaria-HIV negative (r 2 = 0.529; p <0.001). Interpretation & conclusion: In the present study, PCV might be of useful indicator and if not monitored could lead to AIDS establishment especially where high malaria parasitaemia is noted. The findings further suggest that the defined stage of HIV infection in the study, malaria coinfection may moderate the impact of HIV infection on PCV.
27 citations
"Plasmodium falciparum and intestina..." refers background in this paper
...CD4 + T cell counts are used as a measure of immunity and HIV disease progression [11], and counts less than 200cells/μl increase the risk of opportunistic infections....
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TL;DR: Results showed that viral load decreased significantly with time following supplementation, and Mean cell volume and mean cell haemoglobin concentration increased significantly, reflecting the positive effect of the supplement on these haematological parameters.
Abstract: The effect of a nutritional supplement on the immune status and haematological parameters of HIV-positive/AIDS patients is tested using standard procedures. This clinical trial of 35 patients consists of a baseline visit and three months of supplementation from April to September 2003. Results showed that viral load decreased significantly (P<0.002) with time following supplementation. Mean cell volume (MCV) and mean cell haemoglobin concentration (MCHC) increased significantly (P<0.002 and P<0.0002, respectively), reflecting the positive effect of the supplement on these haematological parameters. Supplementation had no effect on CD4+ T-cell count, which decreased significantly with disease progression. Owing to certain limitations of the study (small sample size, short duration and the late stage of HIV infection), further studies are needed to confirm the effect attributed to the supplement.
25 citations
Additional excerpts
...Previously, other authors [14,18] also reported A....
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TL;DR: The study suggests that the fraction of febrile illness attributable to malaria is lower in HIV positive adults, and HIV testing should be considered early in evaluation of patients with suspected malaria.
Abstract: The potential impact of HIV-1 on falciparum malaria has been difficult to determine because of diagnostic problems and insufficient epidemiological data. In a prospective, cross-sectional study, clinical and laboratory data was registered consecutively for all adults admitted to a medical ward in the Central Hospital of Maputo, Mozambique, during two months from 28th October 2006. Risk factors for fatal outcome were analysed. The impact of HIV on the accuracy of malaria diagnosis was assessed, comparing "Presumptive malaria", a diagnosis assigned by the ward clinicians based on fever and symptoms suggestive of malaria in the absence of signs of other infections, and "Verified malaria", a malaria diagnosis that was not rejected during retrospective review of all available data. Among 333 included patients, fifteen percent (51/333) had "presumptive malaria", ten percent (28 of 285 tested persons) had positive malaria blood slides, while 69.1% (188/272) were HIV positive. Seven percent (n = 23) had "verified malaria", after the diagnosis was rejected in patients with neck stiffness or symptom duration longer than 2 weeks (n = 5) and persons with negative (n = 19) or unknown malaria blood slide (n = 4). Clinical stage of HIV infection (CDC), hypotension and hypoglycaemia was associated with fatal outcome. The "presumptive malaria" diagnosis was rejected more frequently in HIV positive (20/31) than in HIV negative patients (2/10, p = 0.023). The study suggests that the fraction of febrile illness attributable to malaria is lower in HIV positive adults. HIV testing should be considered early in evaluation of patients with suspected malaria.
22 citations
"Plasmodium falciparum and intestina..." refers result in this paper
...These findings are consistent with those of previous reports [12, 13]....
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TL;DR: A cryptosporidial infection prevalence of 18% among HIV-infected patients was observed and CD4 + count of <200 cells/μL was a risk factor for acquiring the disease.
Abstract: To determine the prevalence of cryptosporidiosis among HIV infected and HIV non-infected patients with diarrhea in Edo State, Nigeria, as well as the effect of CD4 + lymphocyte count on the prevalence of cryptosporidial infection among the HIV patients. Stool samples were collected from 300 patients consisting of 200 HIV-infected and 100 HIV non-infected patients with diarrhea. Blood samples were collected from the HIV-infected patients. The stool samples were processed to detect Cryptosporidium species using a modified Ziehl-Neelsen stain, as well as other intestinal parasites using saline and iodine preparations. The blood samples were used to determine CD4 + lymphocyte count. The prevalence of intestinal parasites was higher in HIV-infected patients compared with their HIV non-infected counterparts (39% vs 24% respectively, p=0.0097). Cryptosporidiosis was diagnosed only among HIV-infected patients and was the only parasite whose prevalence was significantly different between HIV-infected and HIV non-infected patients. CD4 + lymphocyte count of <200 cells/μL among HIV-infected was a risk factor for acquiring cryptosporidial infection (OR=18.776, 95% CI=6.299, 55.964). A cryptosporidial infection prevalence of 18% among HIV-infected patients was observed and CD4 + count of <200 cells/μL was a risk factor for acquiring the disease. Routine examination of diarrhogenic stools of HIVinfected patients for cryptosporidiosis is advocated.
16 citations