High prevalence of persistent parasitic infections in foreign-born, HIV-infected persons in the United States

• Published in: PLoS neglected tropical diseases Vol. 5; no. 4; p. e1034
• Main Authors: Hochberg, Natasha S, Moro, Ruth N, Sheth, Anandi N, Montgomery, Susan P, Steurer, Frank, McAuliffe, Isabel T, Wang, Yun F, Armstrong, Wendy, Rivera, Hilda N, Lennox, Jeffrey L, Franco-Paredes, Carlos
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.04.2011; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Animals; Antibodies; Blood - immunology; Care and treatment; Chagas disease; Country of birth; Cross-Sectional Studies; Diagnosis; Emigrants and Immigrants; Feces - parasitology; Female; HIV; HIV infection; HIV Infections - complications; Human immunodeficiency virus; Humans; Immigrants; Immune system; Industrialized nations; Infections; Infectious Diseases/Epidemiology and Control of Infectious Diseases; Infectious Diseases/Helminth Infections; Infectious Diseases/HIV Infection and AIDS; Infectious Diseases/Neglected Tropical Diseases; Infectious Diseases/Protozoal Infections; Infectious Diseases/Tropical and Travel-Associated Diseases; Male; Middle Aged; Parasites; Parasitic diseases; Parasitic Diseases - epidemiology; Prevalence; Prevalence studies (Epidemiology); Prevention; Protozoa; Public Health and Epidemiology/Infectious Diseases; Risk factors; Tropical diseases; United States - epidemiology; United States; United States > US; HIV Infections; Emigrants & Immigrants; Prevalence; Cross-Sectional Studies; United States; Humans; Middle Aged; Male; Blood; Animals; Adult; Female; Feces; Parasitic Diseases
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0001034

Foreign-born, HIV-infected persons are at risk for sub-clinical parasitic infections acquired in their countries of origin. The long-term consequences of co-infections can be severe, yet few data exist on parasitic infection prevalence in this population. This cross-sectional study evaluated 128 foreign-born persons at one HIV clinic. We performed stool studies and serologic testing for strongyloidiasis, schistosomiasis, filarial infection, and Chagas disease based on the patient's country of birth. Eosinophilia and symptoms were examined as predictors of helminthic infection. Of the 128 participants, 86 (67%) were male, and the median age was 40 years; 70 were Mexican/Latin American, 40 African, and 18 from other countries or regions. Strongyloides stercoralis antibodies were detected in 33/128 (26%) individuals. Of the 52 persons from schistosomiasis-endemic countries, 15 (29%) had antibodies to schistosome antigens; 7 (47%) had antibodies to S. haematobium, 5 (33%) to S. mansoni, and 3 (20%) to both species. Stool ova and parasite studies detected helminths in 5/85 (6%) persons. None of the patients tested had evidence of Chagas disease (n = 77) or filarial infection (n = 52). Eosinophilia >400 cells/mm(3) was associated with a positive schistosome antibody test (OR 4.5, 95% CI 1.1-19.0). The only symptom significantly associated with strongyloidiasis was weight loss (OR 3.1, 95% CI 1.4-7.2). Given the high prevalence of certain helminths and the potential lack of suggestive symptoms and signs, selected screening for strongyloidiasis and schistosomiasis or use of empiric antiparasitic therapy may be appropriate among foreign-born, HIV-infected patients. Identifying and treating helminth infections could prevent long-term complications.