The best treatment for crypto appears to be antiretroviral (ARV) drugs used to treat HIV. By treating HIV effectively, it's possible to increase CD4 cell counts to levels above 100. In many cases, this has proven to work well for many HIV-positive people with crypto. Unfortunately, crypto can cause malabsorption and may decrease the level of HIV drugs that reach the bloodstream, so people should be monitored closely until their diarrhea has resolved. Antibiotics to treat crypto directly may also be used, but do not work consistently unless they are combined with ARV HIV treatment. It is also important with crypto to guard against dehydration—oral rehydration solutions that include important electrolytes should be used aggressively.
There are actually three different approaches that can be taken when treating crypto: to treat the infection, slow the diarrhea, and correct the weight loss.
One antibiotic, nitazoxanide (Alinia), has been approved for children and adults with crypto, at a dose ranging from 500 to 1,000 mg taken twice a day for 14 days.
Another antibiotic, paromomycin (Humatin), at a doses between 1500 mg and 2000 mg a day, has been shown to both cure the infection or greatly reduce diarrhea associated with the infection. Paromomycin is approved for sale in the United States, albeit not for crypto. In other words, a doctor can still prescribe it, but cryptosporidiosis will not be listed in the package insert.
To help control the diarrhea, perhaps in combination with antibiotic therapy, a number of anti-diarrheal drugs can be taken. These include:
In the event of weight loss, it might be necessary to treat people with crypto using nutritional supplementation. Unfortunately, many nutritional supplements that can be taken by mouth aren't absorbed properly, thus requiring nutritional supplementation through an intravenous (IV) line. This is called total parenteral nutrition (TPN) and, despite its high cost, it can be very effective in providing the body with the nutrients it needs.
Some anabolic agents, such as human growth hormone (Serostim) and anabolic steroids (e.g., Deca-Durabolin, Oxandrin, Winstrol), can be useful in preventing—and perhaps reversing—muscle loss that often occurs in people with weight-reducing infections like crypto.
A syndrome—called immune reconstitution inflammatory syndrome (IRIS)—where antiretroviral treatment can actually exacerbate the symptoms of an opportunistic infection due to a strengthened immune response, has not been reported with crypto.
The most effective way to prevent crypto is to avoid its sources—mainly contaminated drinking water and handling feces from pets and small children. HIV-positive people with severely compromised immune systems are often encouraged to drink bottled or boiled water and not use ice made from unfiltered tap water. It's also best to peel fruits and vegetables and/or wash them thoroughly in boiled water. Washing hands frequently is very important, especially when changing diapers or helping small children use the bathroom or in cleaning litter boxes or picking up after dogs. People with compromised immune systems may also need to avoid eating raw oysters.
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