Enteric parasitic infections in HIV/aids-patients before and after the highly active antiretroviral therapy

Since the description of the first cases of AIDS, a high prevalence of diarrhea due to parasitic diseases in HIV-infected individuals has been reported. Before the onset of highly active antiretroviral therapy (HAART), the prevalence of enteric parasites in HIV/AIDS patients was high in Brazil; after its introduction, this picture seems to have been modified. The aim of this work was to determine and compare the prevalences of intestinal parasites in HIV/AIDS patients who had been admitted at two public hospitals of Fortaleza-CE, Brazil, in the periods before (from January, 1990 to March, 1995) and after (September. 2005 to January, 2007) the introduction of HAART, to see if this form of anti-retroviral treatment contributed to a significant reduction of parasitic diseases in HIV/AIDS patients. Two groups of HIV/AIDS patients of both the sex, of ages 18 years and above were recruited: GROUP I (before-HAART era) with 482 patients and GROUP II (after-HAART era) with 100 patients. Each patient provided a single fresh stool sample for detection of intestinal parasites. The samples were analyzed by the methods of direct microscopy of the stool-smears in saline and Lugol’s iodine, the Lutz’s method, the Baermann-Moraes’ technique and the modified Ziehl-Neelsen staining. About 8 to 10 smears from each fecal sample were analyzed by light microscopy. Intestinal parasites were prevalent in 63,9% of the patients in GROUP I, as follows: hookworms–13,7%, Ascaris lumbricoides–15,6%, Strongyloides stercoralis–30,1%, Trichuris trichiura–13,1%, Cryptosporidium sp.–8,1%, Entamoeba histolytica/dispar–3,3%, Giardia duodenalis–7,9%, Isospora belli–4,8%, and the non-pathogenic species Chilomastix mesnilii-0,6%, Entamoeba coli-17%, Endolimax nana-7,3% and Iodamoeba butschilii-7,1%. In the GROUP II, the general prevalence of intestinal parasites was 24%, and consisted of the following: hookworms–2%, A. lumbricoides–2%, S. stercoralis–11%, T. trichiura, Hymenolepis nana, E. histolytica/dispar, G. duodenalis e I. belli – each specie in 1% of the samples, and the non-pathogenic protozoa Entamoeba coli–8%, Endolimax nana–3% and Iodamoeba butschilii–3%. The coccidian Cryptosporidium sp. was not detected in this group. There was a significant reduction in the prevalence of enteric parasites after onset of HAART, in comparison with the before-HAART period (p<0.0001). The prevalences of the species S. stercoralis, A. lumbricoides, T. trichiura, hookworms, Cryptosporidium sp. and G. duodenalis were significantly reduced between the before-HAART and after-HAART periods (p<0.05). These findings reveal that a significant improvement resulted in the condition of HIV/AIDS patients, with respect to the occurrence of some important enteric parasites, in the after-HAART era, which may have resulted from the introduction the highly active antiretroviral therapy alone, or from the combined influence of HAART, other medicines, better clinical practices and better awareness of the patients to take care of themselves. This work possibly suggests that periodic evaluations of stools for enteric parasites may be of some importance for the assessment of the general health conditions of HIV/AIDS patients under treatment, particularly in those with low CD4+ cell counts.Desde os primeiros casos de AIDS descritos, alta prevalência de diarréia de etiologia parasitária era reportada; antes da terapia anti-retroviral potente (HAART), era elevada a prevalência de enteroparasitos em portadores de HIV/AIDS no Brasil. Com o advento da HAART, isto tem se modificado. O objetivo deste trabalho foi determinar a prevalência de parasitos intestinais em portadores de HIV/AIDS atendidos no Hospital São José de Doenças Infecciosas e no Hospital Universitário Walter Cantídio, em Fortaleza-CE, nas eras pré-terapia anti-retroviral potente – HAART (janeiro de 1990 a março de 1995), retrospectivamente, e pós-HAART (setembro de 2005 a janeiro de 2007), de forma prospectiva, e comparar os achados dos dois períodos. A população do estudo foi composta de 2 grupos de portadores de HIV/AIDS, de ambos os sexos, com idade igual ou superior a 18 anos: GRUPO I – 482 pacientes da era pré-HAART e GRUPO II – 100 pacientes da era HAART. A metodologia consistiu na realização de exame parasitológico de fezes em 01 amostra fecal fresca obtida de cada paciente, sendo executadas as seguintes técnicas: exame direto, a fresco e com lugol; método de Lutz; método de Baermann-Moraes modificado e coloração de Ziehl-Neelsen modificada. Foram lidas de 8 a 10 lâminas por amostra fecal. Os resultados obtidos no GRUPO I revelaram prevalência geral de enteroparasitos de 63,9%, sendo encontrados: ancilostomídeos–13,7%, Ascaris lumbricoides–15,6%, Strongyloides stercoralis–30,1%, Trichuris trichiura–13,1%, Cryptosporidium sp.–8,1%, Entamoeba histolytica/dispar–3,3%, Giardia duodenalis–7,9%, Isospora belli–4,8%, além das espécies não patogênicas Chilomastix mesnilii-0,6%, Entamoeba coli-17%, Endolimax nana-7,3% e Iodamoeba butschilii-7,1%. No GRUPO II a prevalência geral foi de 24%, sendo detectados: ancilostomídeos–2%, A. lumbricoides–2%, S. stercoralis–11%, T. trichiura, Hymenolepis nana, E. histolytica/dispar, G. duodenalis e I. belli – cada uma destas espécies em 1% da amostra, além dos não patogênicos Entamoeba coli–8%, Endolimax nana–3% e Iodamoeba butschilii–3%; o coccídio Cryptosporidium sp. não foi detectado neste grupo. Houve redução significante (p<0,0001) na prevalência geral de enteroparasitos na era HAART em relação à era pré-HAART. Os seguintes parasitos tiveram a prevalência reduzida significativamente na era HAART em relação à era pré-HAART (p