Enteric Parasitic Infections in Relation to Diarrhoea in HIV Infected Individuals with CD4 T Cell Counts < 1000 Cells/mu l in Chennai, India

Aim: This study was conducted to estimate the prevalence of enteric parasites in HIV patients in Chennai and to correlate with CD4 counts and diarrhoeal status. Material and Methods: Faecal specimens from 100 HIV infected individuals with CD4 < 1000/mu l were screened for enteric parasites with wet mounts, modified acid-fast stain for coccidian parasites, modified trichrome stain for Microsporidia, before and after the stool concentration. Agar plate culture for Strongyloides was put up. Chi-square and ANOVA tests were used for statistical analysis. Results: Study group comprised of 38 subjects with acute diarrhoea, 30 with chronic diarrhoea (> 2 weeks) and remaining 32 without diarrhoea. Enteric parasites were detected in 33% of subjects; Isoapora belli (21) being the commonest followed by E. histolyt/Entamoeba dispar (5), Entamoeba coli (2), Cryptosporidium spp (2), Hookworms (2), Strongyloides stercoralis (2), Giardia lamblia (1) and Microsporidium spp (1). There was a significant inverse relation between CD4 counts and duration of diarrhoea. Opportunistic parasites were isolated from the subjects with wide range of CD4 counts and different diarrhoeal status but most commonly from chronic diarrhoea patients. Conclusion: The prevalence of intestinal parasitic infections in HIV patients is high in Chennai, India, especially at CD4 < 1000/mu l, I. belli infection being the commonest. Routine screening of all HIV patients with low CD4 counts for coccidian parasitic infections by using simple stool microscopic techniques can help in early diagnosis and treatment.