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Long-term health is tied to intestinal health
With all of the other problems and opportunistic infections an HIV-infected person might experience, the possibility of parasitic infection might rank low on a list of prevention priorities.
But it should be a top priority for clinicians, says Jon D. Kaiser, MD, medical director of the Wellness Center at California Pacific Medical Center - Davies Campus in San Francisco. Kaiser, who has specialized in HIV and other immune disorders for 12 years, is the author of Healing HIV — How to Rebuild Your Immune System (Mill Valley, CA: HealthFirst Press; 1999).
Besides the most commonly known intestinal parasites — Cryptosporidium and Giardia lamblia — HIV patients often are exposed to Blastocystis hominis, Entamoeba histolytica, Entamoeba coli, Dientamoeba fragilis, Iodamoeba butschlii, Entamoeba hartmanni, and Endolimax nana, Kaiser says.
"They spread through the oral-fecal route and can be spread the same way hepatitis B is spread, through food preparers and also in the water supply," he adds.
Kaiser explains that physicians and other clinicians should be far more concerned about parasites than they have been, because these little bugs can expedite the disease’s progression and cause patients on antiretroviral medications to experience more distress.
"It’s a problem that 95% of physicians know nothing about," Kaiser says. "In medical school, we’re told we don’t need to order any significant tests on the gut unless there are symptoms like diarrhea, and then we’ll order stool samples for parasites."
However, most HIV patients with parasites have no symptoms, Kaiser states. "I have proven this time and time again: A large percentage of patients who complain of no digestive system abnormalities are tested positive for one or more parasites."
Kaiser recommends clinicians check HIV-infected patients each year for parasitic infection. If patients test positive, clinicians should treat them with metronidazole (Flagyl), paramomycin (Humatin), or iodoquinol (Yodoxin), tetracycline, or quinacrine (Atrabine). Then clinicians need to retest the patient four weeks after he or she finishes treatment to make sure the parasites have been eradicated.
Parasitic infection is especially dangerous for HIV patients because if an HIV-positive person has other chronic infections, those infections put stress on the person’s immune system and directly activate cells of the immune system, Kaiser says. "When they are infected with HIV, their body will be more likely to produce HIV viral replication."
Increased viral replication means the patient’s virus will become resistant to antiretroviral drugs more quickly, meaning current treatments will be effective for a shorter time than they otherwise might have been.
In Kaiser’s practice, there have been cases where HIV-infected patients have had breakthrough viral loads of 2,000 to 6,000 copies while on antiretroviral medications. But after they were found to have intestinal parasitic infections and then treated and cured of these, the viral loads have gone back down to undetectable levels without any change in antiretroviral treatment.
Kaiser says recent studies have shown that even when an HIV-infected person is on anti retroviral therapy, there will be some migration of virus to the lymph nodes if the person also has chronic inflammation in his or her gastrointestinal tract due to parasitic infection.