HIV AND PROTOZOAN PARASITES IN BRAZIL: AN UPDATE

Abstract

Parasitic protozoa are still serious reality until today, mainly in developing countries. The association of these parasites with HIV infection can cause severe conditions, either when the virus is acquired after the parasite, or in reverse order. HIV patients are more likely to acquire parasitic infections mainly due to immunosuppression. In addition, a person who already houses a protozoan, even asymptomatic, when infected with HIV becomes more prone to relapses. In relation to HIV-Leishmaniasis co-infection, flaws in the diagnosis of parasites and also in the treatment can be observed. In Brazil, this coinfection is underreported, with many patients being late alerted. Toxoplasmosis is also an important infection in association with HIV, being a frequent cause of brain involvement. Reactivation of the latent parasite usually occurs in many cases. In Brazil, the prevalence of toxoplasmosis in HIV patients can reach 80% in some regions, but serological diagnosis is still enigmatic. Chagas disease is another parasite that can cause severe cases when associated with HIV. The reactivation of chronic parasites is the most frequently observed condition. The Ministry of Health recommends Chagas disease serology to be performed in HIV patients. However, some authors report that this recommendation has not been followed, resulting in coinfection underdiagnosis. Intestinal protozoa are another serious problem when associated with HIV; they can cause chronic diarrheal conditions and even death. As they are parasitic with fecal-oral transmission, deficiencies in basic sanitation aggravate this problem. In Brazil, there is between 4 and 10% of prevalence of these parasites in HIV patients, depending on the studied region. In addition, we should consider a difficulty in this kind of diagnosis, especially of intestinal coccids. Finally, trichomoniasis is a sexually transmitted infection that can increase the risk of HIV transmission and acquisition. In addition, it is associated with resistance to conventional treatment, especially if the patient does not adhere to antiretroviral therapy. So, coinfection protozoan-HIV is still a problem of concern worldwide, especially in Brazil. Diagnostic care measures become necessary for better control of this issue.