Intestinal microsporidiosis among HIV/AIDS patients receiving antiretroviral therapy in Sana�a city, Yemen: first report on prevalence and predictors

Abstract

Background Intestinal microsporidiosis is an opportunistic infection associated with persistent diarrhea among HIV/AIDS patients. In Yemen, however, its epidemiology is unknown. Therefore, this study determined its prevalence and predictors among HIV/AIDS patients receiving antiretroviral therapy (ART) in Sana�a city, the capital of Yemen. Methods This cross-sectional study included 402 patients receiving ART at Al-Jomhori Educational Hospital in Sana�a from November 2019 to December 2020. Data about demographics, clinical characteristics and risk factors were collected using a pre-designed questionnaire. Stool samples were collected and examined for microsporidian spores using the Gram-chromotrope Kinyoun staining. Blood samples were also collected and used for CD4 cell counting by flow cytometry. Univariate analysis was used to test the association of patients� characteristics and risk factors with intestinal microsporidiosis. Multivariable logistic regression was then used to identify the independent predictors of infection. Statistical significance was considered at P-values?<?0.05. Results Intestinal microsporidiosis was prevalent among 14.2% (57/402) of HIV/AIDS patients and was significantly associated with diarrhea (OR 3.4, 95% CI 1.7�6.6; P?=?0.001). The significant independent predictors of infection were?<?200 CD4 cells/�l (AOR 3.2, 95% CI 1.5�6.9; P?=?0.003), not washing hands after contacting soil (AOR 2.5, 95% CI 1.1�5.4; P?=?0.026) and before eating (AOR 3.1, 95% CI 1.5�6.4; P?=?0.003), eating unwashed raw produce (AOR 2.5, 95% CI 1.2�5.3; P?=?0.017) and absence of indoor latrines (AOR 6.2, 95% CI 1.5�25.9; P?=?0.012). Conclusions The prevalence of intestinal microsporidiosis among HIV/AIDS patients in Sana'a is high and comparable to that reported from several other countries, being prevalent among approximately 14.0% of patients and significantly associated with diarrhea. It could be predicted among patients who have?<?200 CD4 cells/�l, have poor hand hygiene after contacting soil and before eating, usually eat unwashed raw produce, or do not possess indoor latrines. Large-scale studies on its epidemiology and predictors among HIV/AIDS patients across the country are warranted.