Last update:
   17-Sep-2004
 

Arch Hellen Med, 18(1), January-Febuary 2001, 43-49

ORIGINAL PAPER

Cryptosporidiosis in ΑΙDS patients after application
of highly active antiretroviral therapy

K. TZANETOU,1 E. SABATAKOU,2 M. CHINI,2 E. KAFKOULA,1 I. PERDIOS,2 E. DOLAPSAKI,1
A. STROUZA,1 M. LELEKIS,2 P. GARGALIANOS,2 E. MALAMOU-LADA1
1Laboratory of Microbiology,
2Special Infections Unit, "G. Gennimatas" District General Hospital of Athens, Athens, Greece

OBJECTIVE The effect of highly active antiretroviral therapy (HAART) on the incidence and outcome of cryptosporidiosis in HIV/AIDS patients is reported.

METHOD In 110 HIV-1 infected patients with diarrhea, fecal specimen examination included (a) parasitological examination for ova and parasites, (b) culture for enteric pathogens and fungi and (c) smear stains for Cryptosporidium and Microsporidium spp.

RESULTS In 4 of the 110 patients (3.6%) oocysts of Cryptosporidium were detected. In 3 patients, the HIV-1 RNA (viral load) and the CD4 lymphocyte count before the initiation of HAART ranged from 244.488x103-842.500x103 copies/mL plasma and from 6-25 CD4 lymphocytes/μL respectively. After a median of 28 (range 26-29) days from initiation of antiretroviral therapy, the diarrhea resolved and the Cryptosporidium oocysts disappeared from the feces, while in the 4th patient who was under HAART, this occurred on the 8th day from initiation of the diarrheal syndrome. The viral load and the CD4 lymphocyte count at the time of cryptosporidiosis eradication ranged from 70-6,435 copies/mL and from 10-51 CD4 lymphocytes/μL, while the respective values, in the 4th patient at the time of diagnosis of Cryptosporidium infection were 2.602x103 copies/mL and 532 CD4 lymphocytes/μL. During follow-up of the 4 patients for a median period of 10 months relapses of the infection were not found.

CONCLUSIONS (a) The severity and duration of diarrhea is clearly associated with the CD4 lymphocyte count (severe diarrheal syndrome was correlated with CD4 lymphocyte count <50 μL, while mild diarrheal syndrome with CD4 lymphocyte count >500/μL). (b) The dramatic decrease of the viral load, even with small or no increase of the CD4 lymphocyte count, after HAART, results in eradication of Cryptosporidium oocysts and diarrhea resolution without administration of any antimicrobial therapy. (c) The best prevention and treatment of cryptosporidiosis in HIV-1 infected patients depends on the use of HAART.

Key words: AIDS, Cryptosporidiosis, HAART, Protease inhibitors.

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