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"If you ignore the gut and its malabsorption or chronic inflammation, which can be caused by underlying infections, you will invariably shorten the duration of action of the antiretroviral cocktail," Kaiser says. "That leads to having to change the drugs quicker and ultimately going through the short list of medications much faster than what you ordinarily need to do."
While clinicians often do not treat these parasites when they infect healthy people because they can clear up on their own, this often is not the case with HIV-infected people. "People who are HIV-positive have a significantly diminished ability to clear their bodies of the parasites," Kaiser says.
Patients who have parasitic infection sometimes have more difficulty tolerating anti retroviral medications, experiencing more gastrointestinal (GI) side effects, Kaiser says, based on his own experiences with patients.
Perhaps the patient had no GI symptoms before starting medication and then suddenly has severe problems. This isn’t always caused solely by the drugs.
"I’ve had patients who’ve been unable to tolerate their medications, but when we eradicate the parasite infection, they are able to tolerate them fine," he explains. "Often physicians just assume that a patient is intolerant to certain drugs due to side effects, when the problems might be due to parasites."
Untreated parasitic infections in AIDS patients can cause such severe diarrhea and poor absorption of nutrients that the patient dies from wasting illnesses. Parasitic infections also make patients more susceptible to other infections because they weaken the host.
"They put an added stress on the immune system," Kaiser says. He advises all clinicians to check for parasites in HIV-infected patients at least once a year. Clinicians should educate their patients about the dangers of parasitic infection.
"First I tell patients that if they’re practicing safe sex with regards to HIV, they can still get parasites through sexual activity because parasites can live outside of the body on condoms and cigarettes," Kaiser says. "Whereas HIV dies in a few minutes, parasites can live for hours."
It may not be necessary for people to boil their water and food, but it is important for them to use common-sense guidelines when eating outside the home. In cases where patients become re-infected with parasites, it might be necessary to test other people in their homes to find the source of recontamination.
"The most important point is that subclinical infections of the gut can set up an unhealthy environment, which activates T-cells and causes them to be more likely to increase viral replication," Kaiser adds.
[Editor’s note: For more information about the book Healing HIV — How to Rebuild Your Immune System, written by Jon D. Kaiser, MD, you may contact HealthFirst Press in Mill Valley, CA, at (888) HEAL-HIV or (888) 432-5448. The book was published in 1999 and costs $19.95.]