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M9650338.TXT
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1996-03-09
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Document 0338
DOCN M9650338
TI Epidemiology of isosporiasis among persons with acquired
immunodeficiency syndrome in Los Angeles County.
DT 9605
AU Sorvillo FJ; Lieb LE; Seidel J; Kerndt P; Turner J; Ash LR; HIV
Epidemiology Program, Los Angeles County Department of Health; Services,
California, USA.
SO Am J Trop Med Hyg. 1995 Dec;53(6):656-9. Unique Identifier : AIDSLINE
MED/96155964
AB To determine factors associated with isosporiasis in persons with
acquired immunodeficiency syndrome (AIDS) in Los Angeles County, data
from the AIDS surveillance registry were analyzed for the eight-year
period 1985-1992. Isosporiasis was reported in 127 (1.0%) of 16,351
persons with AIDS during the study period. Prevalence of infection was
highest among foreign-born patients (3.2%), especially those from El
Salvador (7.4%) and Mexico (5.4%), and in all persons of Hispanic
ethnicity (2.9%). Persons with a history of Pneumocystis carinii
pneumonia (PCP) were less likely than PCP-negative patients to have
isosporiasis (0.2% and 1.4%, respectively, P < 0.01). A decrease in the
prevalence of isosporiasis in patients negative for PCP was observed
beginning in 1989 (P = 0.02). Prevalence decreased with age (P < 0.01,
by chi-square test for trend). After controlling for multiple factors by
logistic regression, isosporiasis was more likely to occur in
foreign-born patients than in those born in the United States (adjusted
odds ratio [OR] = 5.8, 95% confidence interval [CI] 3.4, 9.9, P < 0.001)
and in Hispanics than in whites (non-Hispanics) (adjusted OR = 3.5, 95%
CI 1.7, 7.2, P < 0.001). A prior history of PCP continued to be
negatively associated with isosporiasis (adjusted OR = 0.2, 95% CI 0.1,
0.3, P < 0.001). Age and time remained independently associated with
infection. These data suggest that isosporiasis among persons with AIDS
in Los Angeles County may be related to travel exposure and/or recent
immigration and that the use of trimethoprim-sulfamethoxazole (TMP-SMX)
for PCP may effectively prevent primary infection or expression of
latent isosporiasis. Physicians should have an increased index of
suspicion for Isospora in AIDS patients with diarrhea who have
immigrated from or traveled to Latin America, among Hispanics born in
the United States, in young adults, and in those not receiving PCP
prophylaxis. Food and water precautions should be advised and TMP-SMX
prophylaxis considered for the prevention of Isospora infection for
patients with human immunodeficiency virus infection who travel to Latin
America and other developing countries.
DE Adolescence Adult Aged Animal Antimalarials/THERAPEUTIC USE
AIDS-Related Opportunistic Infections/DRUG THERAPY/*EPIDEMIOLOGY
Coccidiosis/DRUG THERAPY/*EPIDEMIOLOGY Ethnic Groups Female Human
*Isospora Los Angeles/EPIDEMIOLOGY Male Middle Age Odds Ratio
Population Surveillance Prevalence Registries Risk Factors
Trimethoprim-Sulfamethoxazole Combination/THERAPEUTIC USE JOURNAL
ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).