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  • Title: Parasitic disease screening among HIV patients from endemic countries in a Toronto clinic.
    Author: Costiniuk CT, Cooper CL, Doucette S, Kovacs CM.
    Journal: Can J Infect Dis Med Microbiol; 2012; 23(1):23-7. PubMed ID: 23450241.
    Abstract:
    BACKGROUND: Many North American-based HIV patients originate from parasitic disease-endemic regions. Strongyloidiasis, schistosomiasis and filariasis are important due to their wide distribution and potential for severe morbidity. OBJECTIVES: To determine the prevalence, as determined by serological screening, of strongyloidiasis, schistosomiasis and filariasis among patients in an HIV-focused, primary care practice in Toronto, Ontario. A secondary objective was to determine factors associated with positive serological screens. METHODS: A retrospective review of electronic patient records was conducted. Results of serological screens for parasites and relevant laboratory data were collected. RESULTS: Ninety-seven patients were identified. The patients' mean CD4(+) count was 0.45×10(9)/L, median viral load was undetectable and 68% were on highly active antiretroviral therapy (HAART). Most originated from Africa (37%) and South America (35%). Of the 97 patients, 10.4% and 8.3% had positive or equivocal screening results for strongyloidiasis, respectively, 7.4% and 4.2% had positive or equivocal screening results for schistosomiasis and 5.5% and 6.8% had positive or equivocal screens for filariasis. Persons with positive parasitic serologies were more often female (28% versus 9%, P=0.03), younger in age (36 versus 43 years of age, P<0.01), had been in Canada for a shorter duration (5 versus 12 years, P<0.0001) and had a higher viral load (10,990 copies/mL versus <50 copies/mL, P <0.001). All patients were asymptomatic. Eosinophilia was not associated with positive screening results. CONCLUSIONS: Using symptoms and eosinophilia to identify parasitic infection was not reliable. Screening for strongyloidiasis and schistosomiasis among patients with HIV from parasite-endemic countries is simple and benign, and may prevent future complications. The clinical benefits of screening for filariasis require further elucidation, but this practice appears to be the least warranted. BACKGROUND: Many North American-based HIV patients originate from parasitic disease-endemic regions. Strongyloidiasis, schistosomiasis and filariasis are important due to their wide distribution and potential for severe morbidity. OBJECTIVES: To determine the prevalence, as determined by serological screening, of strongyloidiasis, schistosomiasis and filariasis among patients in an HIV-focused, primary care practice in Toronto, Ontario. A secondary objective was to determine factors associated with positive serological screens. METHODS: A retrospective review of electronic patient records was conducted. Results of serological screens for parasites and relevant laboratory data were collected. RESULTS: Ninety-seven patients were identified. The patients’ mean CD4+ count was 0.45×109/L, median viral load was undetectable and 68% were on highly active antiretroviral therapy (HAART). Most originated from Africa (37%) and South America (35%). Of the 97 patients, 10.4% and 8.3% had positive or equivocal screening results for strongyloidiasis, respectively, 7.4% and 4.2% had positive or equivocal screening results for schistosomiasis and 5.5% and 6.8% had positive or equivocal screens for filariasis. Persons with positive parasitic serologies were more often female (28% versus 9%, P=0.03), younger in age (36 versus 43 years of age, P<0.01), had been in Canada for a shorter duration (5 versus 12 years, P<0.0001) and had a higher viral load (10,990 copies/mL versus <50 copies/mL, P <0.001). All patients were asymptomatic. Eosinophilia was not associated with positive screening results. CONCLUSIONS: Using symptoms and eosinophilia to identify parasitic infection was not reliable. Screening for strongyloidiasis and schistosomiasis among patients with HIV from parasite-endemic countries is simple and benign, and may prevent future complications. The clinical benefits of screening for filariasis require further elucidation, but this practice appears to be the least warranted. HISTORIQUE: De nombreux patients atteints du VIH qui vivent en Amérique du Nord proviennent de régions où les parasitoses sont endémiques. La strongyloïdose, la schistosomiase et la filariose sont importantes, en raison de leur vaste répartition géographique et de leur potentiel de grave morbidité. OBJECTIFS: Déterminer la prévalence, établie par dépistage sérologique, des strongyloïdoses, des schistosomiases et des filarioses chez les patients d’un cabinet de soins primaires axés sur le VIH de Toronto, en Ontario. Un objectif secondaire consistait à déterminer les facteurs associés à des dépistages sérologiques positifs. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des dossiers électroniques des patients. Ils ont colligé les résultats des tests de dépistage sérologiques des parasites et les données de laboratoire pertinentes. RÉSULTATS: Les chercheurs ont repéré 97 patients, dont la numération de CD4 moyenne s’élevait à 0,45×109/L, dont la charge virale moyenne était indétectable et dont 68 % prenaient un traitement antirétroviral hautement actif (HAART). La plupart étaient originaires de l’Afrique (37 %) et de l’Amérique du Sud (35 %). Parmi les 97 patients, 10,4 % et 8,3 % avaient respectivement obtenu des résultats de dépistage positifs ou équivoques de strongyloïdose, 7,4 % et 4,2 %, des résultats de dépistage positifs ou équivoques de schistosomiase et 5,5 % et 6,8 %, des résultats de dépistage positifs ou équivoques de filariose. Les personnes obtenant une sérologie parasitaire positive étaient surtout des femmes (28 % par rapport à 9 %, P=0,03), étaient plus jeunes (36 ans par rapport à 43, P<0,01), étaient au Canada depuis moins longtemps (5 ans par rapport à 12, P<0,0001) et avaient une charge virale plus élevée (10 990 copies/mL par rapport à moins de 50 copies/mL, P<0,001). Tous les patients étaient asymptomatiques. Les éosinophiles ne s’associaient pas à des résultats de dépistage positifs. CONCLUSIONS: L’observation des symptômes et des éosinophiles n’était pas fiable pour diagnostiquer une infection parasitaire. Le dépistage de la strongyloïdose et de la schistosomiase chez les patients atteints du VIH provenant de pays endémiques aux parasites est à la fois simple et anodin, sans compter qu’il peut prévenir de futures complications. Il faudra mieux préciser les bienfaits cliniques du dépistage de la filariose, mais cette pratique semble la moins justifiée.
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