G. Angarano et al., GIARDIASIS IN HIV - A POSSIBLE ROLE IN PATIENTS WITH SEVERE IMMUNE-DEFICIENCY, European journal of epidemiology, 13(4), 1997, pp. 485-487
We report the epidemiological, clinical and therapeutic characteristic
s of giardiasis in a population of HIV-infected patients with diarrhoi
c syndrome. During the period between 1988 and 1995, 720 HIV-patients
with diarrhoic syndrome were evaluated. Fecal specimens were submitted
to parasitological examination according to the Ritchie formalin-ethi
l acetate centrifugal sedimentation method and stained with iodine. Sa
mples also underwent modified Ziehl-Neelsen staining and standard bact
eriologic testing. Cystis of G. intestinalis were identified in stool
sample of 25 patients. Two patients were classified as in stage A2 and
23 in C3. Mean CD4 values of patients with giardiasis (26.9 cells/mmc
) were compared with those of 65 patients from whom, during the study,
was isolated Cryptosporidium parvum (63.12, cells/mmc): the differenc
e resulted highly significant (p < 0.001). Among the patients with ful
l-blown AIDS, giardiasis occurred following a single previous AIDS-def
ining event in 13 inividuals, in seven and in five subjects giardiasis
was the 3rd and, respectively, the 4th relevant AIDS-defining conditi
on. Death occurred within the following 2 months in nine patients and
within 6, 12 and 24 months in seven, six and two patients, respectivel
y; at present only three AIDS patients are still alive. In general, G.
intestinalis in HIV+, is not considered a major cause of enteritis; n
evertheless, in our experience enteritis due to G. intestinalis is a f
requent event among AIDS patiens, especially in the most advanced stag
e of disease, irrespectively of the risk factor. The increase in mean
survival of AIDS patients will probably lead to a progressive emergenc
e of this pathogen which could determine a severe diarroic syndrome wi
th hydroelectrolytic impairments.