Diarrhea, CD4+ cell counts and opportunistic protozoa in Indian HIV-infected patients

The aim of this study was to examine the relationships among diarrhea, CD4(+) cell counts and opportunistic protozoa in HIV-infected patients in North India. In a retrospective study, blood and stool samples of 200 HIV-infected patients from March 2001 until 2003, submitted to the AIDS division of National Institute of Communicable Diseases (NICD), were analyzed. Each patient was examined for opportunistic protozoa, HIV-1 status and CD4(+) cell counts, and screened for diarrheal symptoms. The rate of diarrhea was 38% in the stool examination. In HIV-infected patients in the groups CD4(+) > 500 cells/mu L, 200 cells/ mu L < CD4(+) < 500 cells/mu L and in the AIDS patients CD4(+) < 200 cells/mu L, diarrhea was 14.7, 29.8 and 56.1%, respectively. It is clear that the diarrhea in the AIDS patients was significant compared with the two former groups ( P< 0.0005). In the AIDS patients CD4(+) < 200 cells/ mu L with diarrhea, Cryptosporidium infection was, at 56.5%, the highest and statistically significant compared with the other parasites ( P = 0.037). Microsporidium was detected in 30.4% of the AIDS patients. Diarrhea was common and most strongly associated in patients with low CD4(+) cell counts. The data stress the importance of opportunistic protozoa in the HIV-infected patients, and that opportunistic protozoa should be expected in HIV-infected patients with low CD4(+) and diarrhea.