443. Strongyloides Stercoralis in AIDS: Recognition and Management
Session: Poster Abstract Session: HIV Challenges and Complications
Friday, October 21, 2011
Room: Poster Hall B1
Background: The prevalence of Strongyloides Stercoralis in AIDS patients in the US is currently unknown. There are rare reports of S. Stercoralis in AIDS patients associated with dissemination or possible immune reconstitution inflammatory syndrome phenomenon post ART initiation. It is clear the incidence and management of Strongyloides infection in HIV needs to be established. 

Methods: 107 HIV-infected adult participants were prospectively sampled from a Cohort Observational study of anti-retroviral therapy (ART) naïve HIV-1 Infected Patients With CD4 Count < 100 Cells/mL. Data (symptoms, use of corticosteroids, eosinophilia, CD4 count and plasma HIV-RNA) were extracted from clinical records. Serum was tested by enzyme immunoassay (EIA) and luciferase immunoprecipitation system assay (LIPS) for Strongyloides antibodies.  Mann-Whitney and Kruskal-Wallis tests were used for statistical comparisons of median values.

Results: The cohort median age was 40 years (32-47), CD4 count was 22 cells/ml (4-47) and HIV-RNA was 127,586 copies/ml (36048-282667). No statistically significant differences in age, CD4 count and HIV-RNA existed between EIA positive and negative groups.  8% were Strongyloides serology positive by EIA and had lived in the US a median of 6 years (5-7). 74% of EIA positive patients immigrated from areas of high endemnicity.  The remaining 26% were US born and tested negative for Strongyloides by LIPS. EIA positive patients presented with diarrhea (32%), abdominal pain (21%), dermatitis (68%), and eosinophilia (74%). EIA positive patients on corticosteroid therapy did not present with eosinophilia and were treated with ivermectin. One positive EIA case of persistent urticaria starting one month after ART initiation and resolving after ivermectin therapy was considered a probable immune reconstitution event secondary to Strongyloides.

Conclusion: Strongyloides infection as documented by positive serology is highly prevalent in patients with AIDS in the US. Eosinophilia, common in this setting, is frequently masked when corticosteroids are administered for underlying opportunistic infections. Our data suggest that empiric ivermectin therapy is justified in patients with AIDS originating from Strongyloides endemic areas.


Subject Category: H. HIV/AIDS and other retroviruses

Linda Nabha, MD1, Sonya Krishnan, BS2, Gregg Roby, RN1, Roshan Ramanathan, MD1, Rojelio Mejia, MD3, Thomas Nutman, MD, FIDSA3 and Irini Sereti, MD1, (1)National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, (2)Clinical Research Directorate/Clinical Monitoring Research Program, SAIC-Frederick, Inc., NCI-Frederick, Funded by NCI Contract No. HHSN261200800001E, Frederick, MD, (3)Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD

Disclosures:

L. Nabha, None

S. Krishnan, None

G. Roby, None

R. Ramanathan, None

R. Mejia, None

T. Nutman, None

I. Sereti, None

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