CORRELATION OF VIRAL LOAD TO INTESTINAL PARASITOSIS IN HIV SEROPOSITIVE PATIENTS ATTENDING U.I.T.H., ILORIN

Abstract

Intestinal parasitosis is endemic in sub-Saharan Africa, a region with the highest
burden of HIV/AIDS in the world. Although many researchers have defined the
spectrum of intestinal parasites in the HIV seropositive Nigerians and at various
levels of CD4+ counts, there appear to be paucity of information on the
relationship between intestinal parasitosis and viral load among Nigerians living
with HIV/AIDS. The objective of this study was to correlate the pattern and
density of intestinal parasitosis in HIV seropositive individuals, to the degree of
their viraemia. A hospital-based, descriptive, cross-sectional study was done
involving 500 participants, comprising of 250 HIV positive patients in the test
group and 250 HIV negative patients in the control group. Participants were
recruited from the HAART clinic and GOPD of UITH, Ilorin. Blood and stool
samples were collected from each participant; the blood was used to screen
participants for HIV infection, CD4+ cell count and HIV viral load estimation. The
stool sample was examined for presence of gastrointestinal parasites.
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Data was analysed using the Statistical Package for Social Sciences (SPSS),
statistical software package version 19, licensed to IBM Company since 2009.
Results were presented in tabular forms and figures as found applicable.
Categorical variables were compared by Chi square test and continuous variables
were described by means ± SD and compared by the Student’s T-test. Statistical
significance was tested at predetermined p-value of <0.05. Other statistical tests
used were Spearman Correlation, Pearson Correlation, Receiver Operating
characteristic (ROC) curve which was drawn using the MedCalc® software,
Analysis of Variance (ANOVA) and the Least Significant Difference (LSD) test
was used when ANOVA is statistically significant to determine the smallest
significant result between two means, enabling direct comparism of two means
from two groups. Results were presented in tabular forms and figures as found
applicable.
The prevalence of intestinal parasitosis of 60.8% in HIV positive patients was
significantly higher than 16.4% in HIV negative controls (p<0.001). Single
intestinal parasitosis is commoner (48.8%) than multiple parasitosis (12.0%) in the
HIV positive test group. Parasites identified from test subjects were Ascaris
lumbricoides (10.4%), hookworm (3.6%), Strongyloides stercoralis (2%) and the
coccidian parasites (55.6%). The coccidian parasites are statistically significantly
(p<0.001) present in HIV positives (55.6%) compared to HIV negative controls
(6.8%). Diarrhea is significantly present in HIV positives compared with HIV
negatives (p=0.001), and diarrhea in HIV positives is significantly associated with
intestinal parasitosis (p=0.001). The mean CD4+ count of the HIV patients was
232.1 ± 189.3 (range 1- 882 cells/μl) while the mean viral load was 372,306 ±
824150.7 (range 20 – 7,369,327 copies/ml). Intestinal parasitosis was seen at
CD4+ cell count of ≤ 207cells/µl and a viral load >7085 copies/ml. A direct
positive correlation between the viral load and the parasite density was obtained,
that is an increase in the viral load will lead to an increase in the parasite density
and vice versa (R= 0.440). An inverse correlation however was seen between the
CD 4 + T cell count and the Parasite Density (R= – 0.269).
Intestinal parasitosis is therefore likely in patients with HIV infection, especially
in those with markedly depressed immunity evident by a low CD4+ cell count and
high viral load. Screening for presence of gastrointestinal parasite at enrolment into
HIV care is very important, particularly when the CD4+ count is below 207cells
/µl and viral load level above 7085copies/ml irrespective of whether patient
presents with diarrhea or not. Instituting prophylactic antiparasitic agents at these
levels of viral load and CD4+ count is advised.

CORRELATION OF VIRAL LOAD TO INTESTINAL PARASITOSIS IN HIV SEROPOSITIVE PATIENTS ATTENDING U.I.T.H., ILORIN