Impact of intestinal parasitic infections on gut epithelial barrier and inflammation among foreign-born persons living with HIV

Systemic inflammation is a major driver of comorbidities in people with HIV (PWH). Increased levels of biomarkers of enterocyte turnover, microbial translocation, and systemic inflammation have been shown to predict morbidity and mortality in PWH on antiretroviral therapy (ART). We conducted a prospective cohort study of foreign-born PWH with undetectable HIV RNA (<20 copies/mL) with and without intestinal parasitic coinfection. Biomarkers of enterocyte turnover (intestinal fatty acid binding protein [I-FABP]), microbial translocation (soluble CD14), and systemic inflammation (soluble CD163) were measured. Stool parasite quantitative PCR (qPCR) testing and Strongyloides stercoralis recombinant IgG ELISA ( Strongy IgG) were utilized to diagnose parasitic infection. Of the 52 participants, 14 (27%) tested positive for infection with Strongyloides stercoralis by Strongy IgG, and 7 (16%) of the 45 participants who provided stool samples tested positive for a parasitic infection (not including Blastocystis ) by stool qPCR. The median sCD14 level in PWH with (+) Strongy IgG was significantly higher than PWH with (-) Strongy IgG (1.69 ug/ml versus 1.48 ug/ml, p=0.03). The median sCD163 in PWH with parasitic infections by qPCR was not significantly different from sCD163 in PWH negative for parasitic infections. I-FABP levels did not differ significantly between groups. Participants with both HIV and intestinal parasite infections had increased levels of sCD14, a marker of microbial translocation that is an independent predictor of mortality in PWH, compared to PWH without parasitic infections. These findings raise concern about the long-term sequelae of intestinal parasitic infections in PWH.