Molecular Epidemiological Investigation Of HIV/AIDS Combined With Intestinal Protozoal Infection In Tengchong, Yunnan

People infected with HIV have their cellular immunity destroyed and their resistance to parasite infections is reduced.Combining HIV/AIDS with intestinal parasites can accelerate disease progression and is one of the leading causes of long-term diarrhea in HIV-infected individuals,and severe cases can lead to death.The data shows that about 80%of AIDS patients die from AIDS-related opportunistic infections,not AIDS itself.30%to 60%of AIDS patients in developed countries have diarrhea symptoms,but in developing countries,this data is as high as 90%,of which,diarrhea caused by intestinal protozoa infection is predominant.Common infection protozoa include Blastocystis hominis,Cryptosporidium spp.,Giardia lamblia,and Entamoeba histolytica.As the immune function of HIV-infected individuals progressively declines,the prolificacy and virulence of intestinal protozoa increase.HIV-infected persons,especially in the later stages of the disease,those with severe immunosuppression and low CD4+ T-lymphocyte counts are more likely to be infected with intestinal protozoa and have more severe gastrointestinal symptoms,which in turn reduces the quality of life of HIV-infected individuals.Increase the mortality rate.At present,the combination of HIV/AIDS with intestinal protozoa is still a neglected public domain,and its harm is often underestimated.Tengchongcounty in Yunnan Province,which is located in the border area,is one of the areas of more serious HIV/AIDSinfection,but the coinfection status of HIV/AIDS with intestinal protozoa has not been systematically investigated and analyzed.Therefor,the molecular epidemiological characteristics,genotype distribution,and influencing factors of coinfected with common intestinal protozoa in HIV/AIDS patients in the area,a cross-sectional survey was conducted in this study.HIV/AIDS individuals(HIV group)and other hospitalized populations(HIV negative individuals,HIV-N group)were recruitedas the study subjects.Fecal samples were tested by PCR for nucleic acid detection,phylogenetic trees were constructed for genotyping,and structured questionnaires were used to collect basic information of the subjects.Univariate and logistic regression analysis were used to analyze the influencing factors of common intestinal protozoa in HIV/AIDS patients.The main findings are as follows:1.Molecular epidemiological characteristics and influencing factors of HIVco-infection with Blastocystis hominis.The infective rates of Blastocystis hominiswere 3.7%(12/324)and 9.47%(48/507)in the HIV carriers group and the HIV-N inpatients group,respectively.The difference between the two group rates was statistically significant(?2=9.803,P<0.05).By univariate analysis and logistic multivariate regression analysis,the factors affecting human infection with B.h in HIV-infected individuals were daily direct drinking of raw water,domestic livestock,CD4+ cell count ?500 cell/?l,and HIV-RNA viral load>50 copies/ml.Byphylogenetic analysis,ST1 type accounted for 25%(3/12),ST4 type accounted for 25%(3/12),ST7 type accounted for 25%(3/12),and ST3 type accounted for 16.7%(2/12),ST12 type accounted for 8.3%(1/12),of which ST1 infection in 3 cases of diarrhea symptoms,ST3 infection in 2 cases of diarrhea symptoms,ST12 only 1 case of infection with diarrhea.2.Molecular epidemiological characteristics and influencing factors of HIV coinfection with Giardia lambliaThe infective rates of Giardia lamblia were 0.93%(3/324)and 2.17%(11/507)in the HIV-infected persons and the other inpatients groups,respectively.There was no significant difference between the tworates(?2=1.846,P>0.05).Univariate analysis and logistic multivariate regression analysis showed that the influencing factors of HIV-infected G.lamblia were CD4+ cell count ?500cell/?land HIV-RNA viral load>50copies/ml.By systematic evolution analysis,the detected G.lambliabelong to a clustered type and ab-aggregation type respectively.By Phylogenetic analysis,the subtype of the detected G.lamblia were all Aggregate A and Aggregate B.H35 and H53 were Aggregate A and all had diarrhea.H172 was Aggregate B.Type,no symptoms of diarrhea,abdominal pain.3.Molecular epidemiological characteristics and influencing factors of HIV coinfection with Entamoeba histolyticaThe the positive detection rate of Entamoeba histolytica were 1.23%(4/324)and 1.97%(10/507)in the HIV group and HIV-N group,respectively.There was no significant difference between the two detection rates(?2=0.650,P>0.05).Univariate and logistic multivariate regression analysis showed that the influencing factors of E.histolytica in HIV-infected patients were CD4+cell count ?500cell/?land HIV-RNA viral load>50copies/ml.The results showed that the direct drinking water is hospitalized population infected with E.histolyticarisk factors.4.Molecular epidemiological characteristics and influencing factors of HIV coinfection with Cryptosporidium spp.The positive detection rate of Cryptosporidiumspp.was 0.62%(2/324)of HIV-infected persons in the whole age group.There was no Cryptosporidium spp.infection in the hospitalized population.The difference in the detection rate was statistically significant(?2=3.972,P<0.05).After statistical analysis,the results showed that daily direct drinking tap water,HIV-RNA viral load>50 copies/mlis the carrier of HIV Risk factors for Cryptosporidium spp infection.The two positive samples of Cryptosporidium spp.were all C.hominis,and all had diarrhea symptoms.5.Epidemiological factors analysis of HIV/AIDS coinfection with intestinal protozoaThe prevalenceof intestinal protozoainfections were 6.48%and 13.61%in the HIV-infected individuals and in the HIV-negative inpatients,respectively.There was a significant difference between the two infection rates(?2=10.400,P<0.05).A stratified analysis of HIV-infected individuals was conducted.After single-factor and logistic regression analysis,the results showed that daily direct drinking tap water,recurrent contact animals,CD4+ cell count?500cell/?l,and HIV-RNA viral load>50 copies/mlwere the carriers of HIV infection in the intestine.Using aqua privy,drinking tap water directlywere the important risk factors of intestinal protozoainfection,.