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. 2019 Sep 27;8(4):165.
doi: 10.3390/pathogens8040165.

Predictors of Failure from Primary Therapy for Giardiasis in San Diego: A Single Institution Retrospective Review

Anjan Debnath  1 , Sharon L Reed  2   3 , Sheldon R Morris  4
Affiliations

Predictors of Failure from Primary Therapy for Giardiasis in San Diego: A Single Institution Retrospective Review

Anjan Debnath et al. Pathogens. .

Abstract

This study aimed to determine the presence of giardiasis among HIV patients in San Diego, the rate of failure of metronidazole treatment, and factors associated with treatment failure. We used a 7 year retrospective single-center case series of HIV-infected individuals with giardiasis at University of California San Diego Medical Center. Data were analyzed for the changes in the hematological, biochemical, and immunologic results at pre- and at-diagnosis levels. We also compared the changes at the diagnosis level among patients who were treated successfully and those who experienced treatment failure as defined by retreatment with a second course of antibiotics. In 29 Giardia lamblia-infected HIV patients, following diagnosis of G. lamblia, there was a non-significant decrement in cluster of differentiation 4 (CD4), but a statistically significant increase in the number of white blood cell (WBC). Other indices did not differ between pre- and at-diagnosis levels. Twenty patients (69%) were treated with a single course of metronidazole or tinidazole and seven patients (24.1%) were treated with more than one course of metronidazole. These seven patients had statistically significant higher hemoglobin at the time of diagnosis, but further studies are required to confirm if this is a consistent finding and if this can predict failure from primary therapy.

Keywords: HIV; giardia; metronidazole; retrospective; treatment failure.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Changes in cluster of differentiation 4 (CD4) (A), platelets (B), white blood cell (WBC) (C), alanine aminotransferase (ALT) (D), creatinine (E), hemoglobin (F), and HIV viral load (G) associated with giardiasis at the pre-diagnosis and at-diagnosis levels.
Figure 1
Figure 1
Changes in cluster of differentiation 4 (CD4) (A), platelets (B), white blood cell (WBC) (C), alanine aminotransferase (ALT) (D), creatinine (E), hemoglobin (F), and HIV viral load (G) associated with giardiasis at the pre-diagnosis and at-diagnosis levels.
Figure 2
Figure 2
Comparison of WBC (A), platelets (B), ALT (C), creatinine (D), CD4 (E), HIV viral load (F), and hemoglobin (G) at the diagnosis level between giardiasis patients who required a single course of metronidazole treatment and those who were treated with multiple courses of metronidazole.
Figure 2
Figure 2
Comparison of WBC (A), platelets (B), ALT (C), creatinine (D), CD4 (E), HIV viral load (F), and hemoglobin (G) at the diagnosis level between giardiasis patients who required a single course of metronidazole treatment and those who were treated with multiple courses of metronidazole.
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