Comorbibities, Opportunistic Infections, and Helminth Infections Among HIV-positive Patients at a Small Hospital in Delhi, India

Introduction: Immunosuppressed people with HIV/AIDS have increased risk for opportunistic infections (OIs), and poverty can exacerbate this risk.  This retrospective cohort study describes the health situation of vulnerable patients receiving care at a small palliative care clinic in Delhi, India, pre-covid-19 pandemic by describing the most frequently occurring OIs, helminth infections, levels of ART adherence, and perceptions of stigma.  

Methods: Demographic information, diagnoses, laboratory test results, and outcomes were collected for all 1,101 HIV-positive patients admitted to this clinic over a four-year period.  We sampled a small subset of 120 patients for patent helminth infections between July 2016 and June 2018.  In September-November 2019, 80 patients in the HBC program were surveyed regarding ART adherence, side effects, and stigma, and an unannounced pill count was conducted for 78 patients participating.  

Results: The most frequently diagnosed and treated OIs were tuberculosis and candidiasis.  Hemoglobin levels were higher for men than other genders (F=5.137; DF=2; p=0.02).  Married individuals had a significantly lower average CD4+ count than single people (F=8.222; DF=2; p=0.01) and widowed people (p=0.01).  Most patients (59.1%; n=652) had CD4+ counts of 350 or less, and women had significantly higher average CD4+ count than men (F=7.236; DF=2; p<0.001).  Helminth infections were present among 27 (18%) of the samples and included Taenia spp. (37%), Ascaris lumbricoides (26%), Trichuris trichiura (22%), hookworm (19%), Strongyloides spp. (7%), and Enterobius vermicularis (4%).  Most patients (79%) were not adherent to ART based on pill count, however, 76% of the patients self-reported adherence.  Half of the HBC patients surveyed reported stigma, and of those patients, 47% reported that stigma influenced their adherence. 

Discussion: Our results are consistent with OIs frequently seen among PLWHA in India; however, our study population demonstrated significant rates of anemia, possibly due to medication adverse effects, anemia of chronic disease, and nutritional iron deficiency.  Knowledge of common helminth infections can inform comprehensive patient health education as helminth infections can exacerbate the effect of OIs and other health effects of HIV and its treatment, especially in situations where ART-associated stigma and side-effects may result in lower adherence than is protective.