Globally about 3.5 billion people are infected with intestinal parasite. Out of whom, 450 million are suffering from its illness [
Antiretroviral treatment (ART) increases the length and quality of life and productivity of patients by improving survival and decreasing the incidence of opportunistic infections in people with HIV through reduction of the viral load and increasing the level of CD4 cells [
Therefore, we investigated the prevalence of intestinal parasites among HIV positive persons who were naive and who were on ART in Hiwot Fana Specialized University Hospital, Eastern Ethiopia.
The study was conducted in Hiwot Fana Specialized University Hospital, Harar, Ethiopia. It is a teaching hospital of Haramaya University. The hospital is found in Harari National Regional State which is one of the Federal Democratic Republic of Ethiopia regional states located 515 km from Addis Ababa. In Harar, there are six hospitals and eight health centers. The health service coverage of the region was estimated to be above 100%. A comparative cross-sectional study was conducted among Naive and on ART HIV positive persons in Hiwot Fana Specialized University Hospital from March to April, 2011.
The study population was all the HIV positive individuals who were on ART and pre ART care in the ART unit of the hospital during the study period. Individuals who were on parasitic treatments during the data collection period were excluded. The prevalence of intestinal parasites among ART-naive group HIV positive individuals was taken as 50% and to detect a difference of 15% between the two groups with the assumption of 95% confidence level (CL), power of 80% (0.84) and ratio 2 : 1 of those on ART and ART-naive group. Double proportion formula was applied to calculate the sample size which was 274 on ART and 137 ART-naive group. A 5% nonresponse rate was added and the final calculated sample size was 431. Study participants were selected by simple random sampling techniques.
Small pieces of labeled clean plastic sheets and wooden applicator sticks were distributed and the participants were instructed to bring sizable stool specimen of their own. With the provision of specimen, each participant was interviewed for sociodemographic variables. Each stool specimen was initially assessed for consistency. Then, it was examined by direct wet mount method using normal saline (0.85% NaCl solution) at Hiwot Fana Specialized University Hospital Laboratory in order to prevent the loss of motile stage of parasites. Lugol’s iodine was used to detect the cyst of intestinal parasites. The remaining sample was preserved with 10% formalin and transported to the laboratory of Medical Laboratory Sciences Department Haramaya University. In the laboratory, it was examined by formol ether concentration technique and modified Zeihl-Neelsen method (for detection of opportunistic parasites—
Data were entered into Epideta Version 3.1 and transported to SPSS Version 16 software for analysis. The prevalence of intestinal parasites was determined in relation to different variables Pearson’s chi square test was used to assess statistical significance difference between proportions. Bivariate and multivariate analyses were performed to assess crude and adjusted ratio. A statistical test result was reported as significant when its
Ethical clearance was obtained from Haramaya University Colleges of Health and Medical Sciences Institutional Research and Ethical Review Committee. All the participants were explained about the purpose and their right to participate or not to participate in this study. Those who gave their written consent participated in this study. Moreover, all personal information of the participants was kept confidential. Those participants who were found positive for intestinal parasitic infection were treated free of charge using the standard drugs by nurses in ART unit. ART follow-up record was also retrieved by nurses working in ART unit.
A total of 259 on ART and 112 ART-naive group HIV positive clients participated in the study, and the response rate was 86.7%. The mean age of the participants was 33.6 (SD ±10.04) and many of the ART-naive group (68.5%) and on ART (70%) participants were female. The majority of the study subjects were in the age group of 25–34, married, daily laborers, and urban dwellers (Table
Sociodemographic characteristics of naïve ART and on ART HIV positive study participants at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia, 2011.
Variables | Naïve ART | On ART | Total |
---|---|---|---|
|
|
|
|
Age (in year) | |||
15–24 | 35 (31.5%) | 40 (15.6%) | 75 (20.4) |
25–34 | 51 (45.9%) | 121 (47.3%) | 172 (46.9) |
≥35 | 25 (22.5%) | 95 (37.1%) | 120 (32.7) |
Sex | |||
Male | 35 (31.5) | 76 (29.3) | 111 (30) |
Female | 76 (68.5) | 183 (70.7) | 259 (70) |
Educational status | |||
Illiterate | 27 (24.1) | 56 (21.6) | 83 (22.4) |
Read and write | 3 (2.7) | 7 (2.7) | 10 (2.7) |
Elementary school | 49 (43.8) | 94 (36.3) | 143 (38.5) |
High school and above | 33 (29.5) | 102 (39.4) | 135 (36.4) |
Marital status | |||
Single | 30 (27.5) | 56 (21.6) | 86 (23.4) |
Married | 55 (50.5) | 112 (43.2) | 167 (45.4) |
Divorced | 14 (12.8) | 55 (21.2) | 69 (18.8) |
Widowed | 10 (9.2) | 36 (13.9) | 46 (12.5) |
Occupation | |||
Government employee | 14 (12.8) | 56 (21.8) | 70 (19.1) |
Nongovernmental organization | 5 (4.6) | 13 (5.1) | 18 (4.9) |
Farmer | 2 (1.8) | 11 (4.3) | 13 (3.6) |
Merchants | 23 (21.1) | 47 (18.3) | 70 (19.1) |
Daily laborer | 27 (24.8) | 66 (25.7) | 93 (25.4) |
House wife | 19 (17.4) | 26 (10.1) | 45 (12.3) |
Students | 1 (0.9) | 3 (1.2) | 4 (1.1) |
Other | 12 (11.0) | 16 (6.2) | 28 (7.7) |
No job | 6 (5.5) | 19 (7.4) | 25 (6.8) |
Residence | |||
Rural | 23 (21.3) | 65 (25.3) | 88 (24.1) |
Urban | 85 (78.7) | 192 (74.2) | 277 (75.9) |
The overall prevalence of intestinal parasites among the study participants was 33.7% (125/371). It was significantly higher in the ART-naive group (45.5% (51/112)) compared to those on ART (28.6% (74/259)) (
Eleven parasite species were detected:
Some of the ART-naive group (26.8%) and few of the on ART (17.4%) subjects were diarrheic (
Intestinal parasite species identified with ART and diarrheic status of HIV positive study participants at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia, 2011.
Parasite species | Naïve ART |
On ART |
Total |
|
Diarrheic |
Nondiarrheic |
|
---|---|---|---|---|---|---|---|
|
15 (13.4) | 35 (13.5) | 50 (13.5) | 0.975 | 10 (13.3) | 40 (13.5) | 0.967 |
|
8 (7.1) | 22 (8.5) | 30 (8.1) | 0.661 | 9 (12) | 21 (7.1) | 0.164 |
|
6 (5.4) | 9 (3.5) | 15 (4.0) | — | 9 (12) | 6 (2) | — |
|
8 (7.1) | 0 (0) | 8 (2.2) | 7 (9.3) | 1 (0.3) | — | |
Hookworm | 3 (2.7) | 4 (1.5) | 7 (1.9) | — | 0 (0) | 7 (2.4) | — |
|
5 (4.5) | 0 (0) | 5 (1.3) | — | 5 (6.7) | 0 (0) | — |
|
1 (0.9) | 4 (1.5) | 5 (1.3) | — | 0 (0) | 5 (1.7) | — |
|
0 (0) | 3 (1.2) | 3 (0.8) | — | 0 | 3 (1.0) | — |
|
2 (1.8) | 1 (0.4) | 3 (0.8) | — | 1 (1.3) | 2 (0.7) | — |
|
2 (1.8) | 1 (0.4) | 3 (0.8) | — | 1 (1.3) | 2 (0.7) | |
|
2 (1.8) | 0 (0) | 2 (0.5) | — | 0 (0) | 2 (0.7) | — |
About 31% (31/100), 17.3% (34/196), and 13.3% (10/75) of the study participants with CD4 count less than 200 cells/
In the bivariate analysis, age, sex, occupation, residence, education, and marital status of the participants did not show significant association with prevalence of intestinal parasites. Participants with CD4 count less than 200 cells/
Associating intestinal parasite with CD4 count and diarrheic and ART status among HIV positive study participants at Hiwot Fana Specialized University Hospital, Eastern Ethiopia, 2011.
Variables | No examined (% pos.) | Crude odds ratio (95% confidence interval) |
|
Adjusted odds ratio (95% confidence interval) |
|
---|---|---|---|---|---|
CD4 count (cells/µL) | |||||
≥500 | 75 (30.7) | 1 | 1 | ||
200–499 | 196 (28.6) | 0.90 (0.51, 1.62) | 0.734 | 0.78 (0.42, 1.42) | 0.409 |
<200 | 100 (46) | 1.93 (1.03, 3.61) | 0.041 | 2.07 (1.06, 4.04) | 0.034 |
Diarrheic status | |||||
Nondiarrheic | 296 (28.7) | 1 | 1 | ||
Diarrheic | 75 (53.3) | 2.84 (1.69, 4.77) | 0.000 | 2.30 (1.34, 3.96) | 0.003 |
ART status | |||||
On ART | 259 (28.6) | 1 | 1 | ||
Naïve ART | 112 (45.5) | 2.09 (1.32, 3.31) | 0.002 | 2.60 (1.56, 4.34) | 0.000 |
Intestinal parasitic infections are the major causes of morbidity and mortality in HIV positive patients [
Several species of protozoa and other intestinal parasites have been associated with acute and chronic diarrhea and even weight loss in HIV/AIDS patients [
Opportunistic protozoa like Crypotospriudum species and
Other nonopportunistic intestinal helimiths were identified at the rate of ranging from 0.5% to 4.0%. The highest prevalent helminth was
In this study, we tried to compare the prevalence of intestinal parasites with the diarrheic status, CD4 count, and ART experience of HIV positive persons. The prevalence of intestinal parasites was significantly higher among diarrheic as compared to nondiarrheic groups. Similar reports are found in other studies [
The association between opportunistic parasitic infection and HIV is widely reported [
The prevalence of intestinal parasites was highly significant among those study participants with CD4 count <200 cells/
The prevalence of intestinal parasites was significantly higher when ART-naive group compared to those on ART study participants. Opportunistic parasites, which are Crypotospriudum species and
The study was not without limitations. The detection method for
The prevalence of intestinal parasite was high. Opportunistic and nonopportunistic parasites were identified with a different rate. The prevalence of intestinal parasites was higher among those HIV infected individuals with diarrhea, low CD4 count, and ART-naive group groups. Those results posit the need for considering early detection and treatment of intestinal parasites in HIV infected individuals in order to reduce their morbidity. This seeks great attention by those clinical service providers who are working in the ART unit. Adherence counseling of ART, health information dissemination on environmental, and personal hygiene should also be given to HIV/AIDS patients. In addition further large scale study by using different diagnostic techniques, HIV negative control and assessing predisposing factors of intestinal parasites is recommended.
The authors acknowledge Haramaya University for funding this research. They also would like to thank all their study participants, data collectors, and supervisors. Hiwot Fana Specialized University Hospital administration is also strongly acknowledged.