Prevalence of Strongyloides stercoralis in an urban US AIDS cohort

Pathog Glob Health. 2012 Aug;106(4):238-44. doi: 10.1179/2047773212Y.0000000031.


Objectives: We examined the prevalence of Strongyloides stercoralis (Ss) infection in a cohort of AIDS patients from a US urban centre. We monitored our cohort for possible cases of dissemination or immune reconstitution inflammatory syndrome after antiretroviral therapy (ART) initiation.

Methods: One hundred and three HIV-infected participants were prospectively sampled from a cohort observational study of ART-naive HIV-1-infected patients with CD4 ≤100 T cells/μl. Clinical symptoms, corticosteroid therapy, eosinophilia, CD4 count, and plasma HIV-RNA were reviewed. Sera were tested by an enzyme-linked immunosorbent assay (CrAg-ELISA) to crude Ss extract or to an Ss-specific recombinant protein (NIE) and by luciferase immunoprecipitation system assay (LIPS) for Ss-specific antibodies.

Results: Twenty-five per cent of study participants were Strongyloides seropositive by CrAg-ELISA and 62% had emigrated from Strongyloides-endemic areas. The remaining 38% of the seropositives were US born and tested negative by NIE and LIPS. CrAg-ELISA-positive participants had a median CD4 count of 22 T cells/μl and a median HIV-RNA of 4·87 log(10) copies/ml. They presented with diarrhea (27%), abdominal pain (23%), and skin manifestations (35%) that did not differ from seronegative patients. Peripheral blood eosinophilia was common among seropositive patients (prevalence of 62% compared to 29% in seronegatives, P = 0·004). Seropositive patients were treated with ivermectin. There were no cases of hyperinfection syndrome.

Discussion: Strongyloidiasis may be prevalent in AIDS patients in the USA who emigrated from Ss-endemic countries, but serology can be inconclusive, suggesting that empiric ivermectin therapy is a reasonable approach in AIDS patients originating from Strongyloides endemic areas.

MeSH terms

  • Acquired Immunodeficiency Syndrome / complications*
  • Acquired Immunodeficiency Syndrome / drug therapy
  • Acquired Immunodeficiency Syndrome / virology
  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Animals
  • Anti-Inflammatory Agents / therapeutic use
  • Anti-Retroviral Agents / therapeutic use
  • Antibodies, Helminth / blood*
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Enzyme-Linked Immunosorbent Assay
  • Eosinophilia / diagnosis
  • Female
  • HIV
  • HIV-1 / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • RNA, Viral / blood
  • Seroepidemiologic Studies
  • Strongyloides stercoralis / immunology*
  • Strongyloidiasis / epidemiology*
  • Strongyloidiasis / pathology
  • United States / epidemiology
  • Urban Population
  • Viral Load


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Anti-Retroviral Agents
  • Antibodies, Helminth
  • RNA, Viral