MODIFICATION OF THE CLINICAL COURSE OF INTESTINAL MICROSPORIDIOSIS INACQUIRED-IMMUNODEFICIENCY-SYNDROME PATIENTS BY IMMUNE STATUS AND ANTI-HUMAN-IMMUNODEFICIENCY-VIRUS THERAPY

The clinical course of 37 Enterocytozoon bieneusi-infected acquired im munodeficiency syndrome patients with diarrhea was studied. Parasite c learance was seen in 15 patients (40.5%). Clearance of E. bieneusi res ulted in a 25-100% reduction in episodes of diarrhea, suggesting that microsporidia are true pathogens. Univariate and multivariate proporti onal hazards analyses revealed that peripheral blood CD4 cell counts g reater than or equal to 100/mm(3), the use of two or more antiretrovir al medications, and use of a protease inhibitor were statistically ass ociated with decreased time to clearance of E. bieneusi. Specific anti -microsporidial therapy (albendazole) was not associated with parasite eradication. Factors related to immunocompetence and human immunodefi ciency virus suppression appeared to be important in the clearance of E. bieneusi.