CYCLOSPORA INFECTION IN ADULTS INFECTED WITH HIV - CLINICAL MANIFESTATIONS, TREATMENT, AND PROPHYLAXIS

Objective: To determine the prevalence and clinical manifestations of Cyclospora in Haitians infected with human immunodeficiency virus (HIV ) who have diarrhea and to evaluate therapy and prophylaxis. Design: C ohort study. From 1990 to 1993, stool samples were collected from adul ts seropositive for HIV who had had diarrhea for at least 3 weeks. Set ting: A clinic in Haiti. Interventions: Stool samples were examined fo r enteric protozoa after acid-fast staining. Patients with Cyclospora infection were treated with trimethoprim-sulfamethoxazole (160 mg and 800 mg, respectively) given orally four times a day for 10 days. After completion of therapy, patients were evaluated weekly and re-treated if clinical and parasitologic recurrences occurred, followed by trimet hoprim-sulfamethoxazole prophylaxis three times a week. Results: 804 o f 2400 patients (33%) seropositive for HIV had a history of chronic or intermittent diarrhea; 502 of these 804 patients (62%) currently had diarrhea, and 450 patients each provided two stool specimens for exami nation. Enteric protozoa identified included Cryptosporidium (30%), Is ospora belli (12%), Cyclospora species (11%), Giardia lamblia (3%), an d Entamoeba histolytica (1%). Forty-three patients with diarrhea and C yclospora infection were studied; their symptoms were indistinguishabl e from those seen in patients with isosporiasis or cryptosporidiosis. In all patients, diarrhea ceased and results from stool examinations w ere negative within 2.5 days after beginning oral tri methoprim-sulfam ethoxazole therapy. Recurrent symptomatic cyclosporiasis developed in 12 of 28 patients (43%) followed for 1 month or more, but it also resp onded promptly to trimethoprim-sulfamethoxazole therapy. These 12 pati ents received trimethoprim-sulfamethoxazole three times a week as seco ndary prophylaxis, with only a single recurrence after 7 months. Concl usion: Cyclospora infection is common in Haitian patients with HIV inf ection, responds to trimethoprim-sulfamethoxazole therapy, and has a h igh recurrence rate that can be largely prevented with long-term trime thoprim-sulfamethoxazole prophylaxis.