INTESTINAL CRYPTOSPORIDIOSIS IN HIV-INFEC TION - CLINICAL-FEATURES, COURSE AND TREATMENT

Objective: To determine retrospectively the clinical features acid cou rse of HIV-associated intestinal Cryptosporidium infection and its res ponse to paromomycin. Patients and methods: Case notes of all patients treated for cryptosporidiosis over a two-year period at an HIV out-pa tient clinic were analysed (26 men, four women; median CD4-lymphocyte count: 20/mu l). Median follow-up time was 6(1-22) months. Results: 15 patients had persistent diarrhoea, two remained asymptomatic, seven h ad a remission and in five the disease took a fulminant course with se vere diarrhoea ending in death within 4 months. 15 of the patients die d during the period of observation, eight of them of cryptosporidiosis -associated cachexia. Mean survival time was about one year. Eight pat ients had multiple intestinal infections at the time the diagnosis was made and seven developed them later, which correlated with the poorer survival chances. Four patients had proven acid 13 probably cryptospo ridiosis-associated involvement of the biliary tract, but this did not affect the survival chances. 21 of 28 patients with diarrhoea were tr eated with paromomycin. In 13 of them there was for a time complete or partial response to treatment, but no response in eight; Those who re sponded well or partially to paromomycin had a significantly better su rvival chance than those without response. There was no correlation be tween the severity of immunosuppression and the severity of the crypto sporidiosis-associated diarrhoea, the response to paromomycin and the worse survival chance in the presence of multiple intestinal infection s. Conclusions: The reasons for the different courses taken by HIV-ass ociated cryptosporidiosis and the different therapeutic responses rema in unclear. There is no known causal treatment, but 60% of patients im proved temporarily on paromomycin.