Albendazole chemotherapy for AIDS-related diarrhoea in Zambia - Clinical, parasitological and mucosal responses

Background: Albendazole reduces diarrhoea in African AIDS patients, but it is unclear if the clinical response to treatment reflects pathogen eradication and/or mucosal recovery. Methods: Adults with HIV-related persistent diarrhoea were treated with albendazole 800 mg twice daily for 14 days. Clearance of parasites was evaluated at 3 and 6 weeks by stool microscopy. At baseline and at 6 weeks duodenal biopsies were taken for electron microscopy (EM) and morphometry. Results: Ten (7%) of 153 patients had cryptosporidiosis, 54 (37%) had isosporiasis and 23 (16%) had microsporidiosis. By 3 weeks, these protozoa were cleared in 27 (46%) of 59 patients initially positive, By 6 weeks, 34 (39%) of 87 patients experienced complete clinical response, 18 (21%) partial response and 35 (40%) no response. Crypt depth increased by 15% over 6 weeks (P < 0.001), but villous height increased only in patients with complete response (median + 50 μm, interquartile range (IQR) 2-90, compared to patients with partial (+ 4 μm, IQR - 15,41) or no response (- 13 μm, IQR - 62,12; P = 0.008)). Fifteen patients died: body mass index ≤ 17.5 kg/m2 and crypt depth ≤ 180 μm independently predicted death. Conclusions: Albendazole therapy reduced the burden of protozoal infection and promoted mucosal recovery in patients with a complete clinical response.