Levels of serum HIV-1 RNA viral load in tuberculosis patients with or without intestinal parasites during treatment of tuberculosis in Gondar, Ethiopia

Background: HIV-1 RNA viral load is a powerful predictor of risk for disease progression in subjects infected with HIV. However, studies assessing VL in co-infected patients are very scarce. This study was, therefore, aimed at determining VL in tuberculosis (TB) and HIV-1 co-infected patients with or without intestinal parasites and also to assess its variation with treatment.

Methods: TB was diagnosed following standard clinical, bacteriological, radiological and histological procedures. HIV serostatus was checked by enzyme linked immunosorbent assay. One hundred nineteen TB/HIV-1 co-infected patients were includedas a baseline and 22 were re-examined at the end of intensive phase of anti-TB chemotherapy. Stool samples were examined for intestinal parasites by conventional microscopy and serum viral load was determined using an Amplicor HIV-1 Monitor RTPCR assay.

Results: Forty-five (37.8%) patients were found infected with one or more species of intestinal parasites. Ascaris lumbricoides and Strongyloides stercoralis were the most frequently detected species. The mean (±SD) serum viral load (log10 RNA copies/ ml) of patients at baseline was 4.82 (±0.66) without a significant difference by status of intestinal parasitoses. In patients with follow up treatment the viral load declined from 4.84 (±0.45) to 4.52 (±0.66) at the end of the intensive phase of anti-TB chemotherapy (P=0.07). In five patients who were also treated for intestinal parasites, viral load declined from 5.02 (±0.38) to 4.47 (±0.66) (P<0.05). A mean increase of 0.58 (±0.33) was seen in seven patients (P<0.01).

Conclusion: The lack of significant decline in viral load at the end of the intensive phase of anti-TB treatment may indicate increased morbidity in the patients. Intervention measures such as provision of anti-retroviral and anti-parasite therapy may help to reduce morbidity.