Isosporiasis in patients with HIV infection in the highly active antiretroviral therapy era in France

• Published in: HIV medicine Vol. 9; no. 2; pp. 126 - 130
• Main Authors: Lagrange‐Xélot, M, Porcher, R, Sarfati, C, De Castro, N, Carel, O, Magnier, J‐D, Delcey, V, Molina, J‐M
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-02-2008
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Infective Agents - therapeutic use; Antiretroviral Therapy, Highly Active; cotrimoxazole; Diarrhea - epidemiology; Diarrhea - parasitology; Diarrhea - virology; diarrhoea; Female; HIV; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - epidemiology; Humans; isosporiasis; Isosporiasis - drug therapy; Isosporiasis - epidemiology; Isosporiasis - virology; Male; Middle Aged; Paris - epidemiology; Prevalence; Recurrence; relapse; Retrospective Studies; sub‐Saharan Africa; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use; Paris
• ISSN: 1464-2662; 1468-1293
• DOI: 10.1111/j.1468-1293.2007.00530.x

Background
Isosporiasis, a rare cause of diarrhoea among HIV‐infected patients in the pre‐highly active antiretroviral therapy (HAART) era, seems to be re‐emerging.
Methods
A retrospective study was carried out for the period 1995–2003 in two hospitals in Paris to describe the prevalence, clinical characteristics and therapeutic outcome of isosporiasis in HIV‐infected patients, and to compare the findings with those for cryptosporidiosis and microsporidiosis.
Results
The prevalence of isosporiasis increased from 0.4 per 1000 patients in the pre‐HAART era (1995–1996) to 4.4 per 1000 patients in the HAART era (2001–2003), whereas the prevalence of cryptosporidiosis and microsporidiosis decreased. Compared with patients with either cryptosporidiosis (n=91) or microsporidiosis (n=58), patients with isosporiasis (n=28) more frequently originated from sub‐Saharan Africa (72%), were more frequently female and heterosexual, and had a higher median CD4 count at diagnosis (142 cells/μL). All patients with isosporiasis presented with diarrhoea, which was severe enough to lead to hospital admission for 60% of them. Fever was uncommon (7%). All patients were treated for isosporiasis, 27 of them with cotrimoxazole. Relapse of isosporiasis occurred in six of 16 patients (38%) despite maintenance cotrimoxazole therapy and HAART.
Conclusion
Isosporiasis in France occurs mostly in patients emigrating from sub‐Saharan Africa and can induce severe diarrhoea. Relapse is common despite cotrimoxazole maintenance therapy.