Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection

A case-control study in Lima, Peru

César Cárcamo, Thomas Hooton, Mark H. Wener, Noel S. Weiss, Robert Gilman, Jorge Arevalo, Juan Carrasco, Carlos Seas, Martin Caballero, King K. Holmes

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective. We sought to determine the etiologies, manifestations, and risk factors for persistent (&7 days) diarrhea in human immunodeficiency virus type 1 (HIV-1)-infected persons in Peru. Design. The present study is a case-control study of 147 HIV-1-infected case subjects with persistent diarrhea and 147 HIV-1-infected control subjects without diarrhea. Methods. We obtained clinical, demographic, and exposure data, CD4 lymphocyte counts, and stool samples for detection of enteric parasitic and bacterial pathogens and rotavirus. Results: One or more enteric pathogen was identified in 55% of case subjects and 21% of control subjects (odds ratio adjusted for CD4 lymphocyte count, 3.8; 95% confidence interval, 2.2-6.5). The median CD4 lymphocyte count was highest with pathogen-free diarrhea and lowest with Cryptosporidium infection. Cryptosporidium species (the most frequent pathogen), Giardia lamblia, Aeromonas species, Campylobacter species, and rotavirus were all significantly associated with diarrhea. Bacterial pathogens were significantly associated with G. lamblia and rotavirus infection. Of the bacterial pathogens (Aeromonas, Campylobacter, Salmonella, and Vibrio species and enterotoxigenic Escherichia coli), only 24% were susceptible to cotrimoxazole, whereas 90% were susceptible to ciprofloxacin. In no case did the sensitivity or positive predictive value of specific clinical and laboratory findings for curable enteric infections exceed 50%. Conclusions. Several enteric pathogens were associated with diarrhea in HIV-1-infected case subjects in Peru, especially among those who were heterosexual. Clinical findings were poor predictors of detectable microbial etiology. The guidelines for initial management of chronic diarrhea with sulfamethoxazole-trimethoprim in HIV-1-infected persons require revision, at least in settings where prophylaxis with this agent is common.

Original languageEnglish
Pages (from-to)11-19
Number of pages9
JournalJournal of Infectious Diseases
Volume191
Issue number1
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

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Peru
Virus Diseases
HIV-1
Case-Control Studies
Diarrhea
CD4 Lymphocyte Count
Aeromonas
Giardia lamblia
Cryptosporidium
Campylobacter
Rotavirus
Sulfamethoxazole Drug Combination Trimethoprim
Rotavirus Infections
Enterotoxigenic Escherichia coli
Vibrio
Heterosexuality
Ciprofloxacin
Infection
Salmonella
Odds Ratio

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Immunology

Cite this

Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection : A case-control study in Lima, Peru. / Cárcamo, César; Hooton, Thomas; Wener, Mark H.; Weiss, Noel S.; Gilman, Robert; Arevalo, Jorge; Carrasco, Juan; Seas, Carlos; Caballero, Martin; Holmes, King K.

In: Journal of Infectious Diseases, Vol. 191, No. 1, 01.01.2005, p. 11-19.

Research output: Contribution to journalArticle

Cárcamo, C, Hooton, T, Wener, MH, Weiss, NS, Gilman, R, Arevalo, J, Carrasco, J, Seas, C, Caballero, M & Holmes, KK 2005, 'Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: A case-control study in Lima, Peru', Journal of Infectious Diseases, vol. 191, no. 1, pp. 11-19. https://doi.org/10.1086/426508
Cárcamo, César ; Hooton, Thomas ; Wener, Mark H. ; Weiss, Noel S. ; Gilman, Robert ; Arevalo, Jorge ; Carrasco, Juan ; Seas, Carlos ; Caballero, Martin ; Holmes, King K. / Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection : A case-control study in Lima, Peru. In: Journal of Infectious Diseases. 2005 ; Vol. 191, No. 1. pp. 11-19.
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abstract = "Objective. We sought to determine the etiologies, manifestations, and risk factors for persistent (&7 days) diarrhea in human immunodeficiency virus type 1 (HIV-1)-infected persons in Peru. Design. The present study is a case-control study of 147 HIV-1-infected case subjects with persistent diarrhea and 147 HIV-1-infected control subjects without diarrhea. Methods. We obtained clinical, demographic, and exposure data, CD4 lymphocyte counts, and stool samples for detection of enteric parasitic and bacterial pathogens and rotavirus. Results: One or more enteric pathogen was identified in 55{\%} of case subjects and 21{\%} of control subjects (odds ratio adjusted for CD4 lymphocyte count, 3.8; 95{\%} confidence interval, 2.2-6.5). The median CD4 lymphocyte count was highest with pathogen-free diarrhea and lowest with Cryptosporidium infection. Cryptosporidium species (the most frequent pathogen), Giardia lamblia, Aeromonas species, Campylobacter species, and rotavirus were all significantly associated with diarrhea. Bacterial pathogens were significantly associated with G. lamblia and rotavirus infection. Of the bacterial pathogens (Aeromonas, Campylobacter, Salmonella, and Vibrio species and enterotoxigenic Escherichia coli), only 24{\%} were susceptible to cotrimoxazole, whereas 90{\%} were susceptible to ciprofloxacin. In no case did the sensitivity or positive predictive value of specific clinical and laboratory findings for curable enteric infections exceed 50{\%}. Conclusions. Several enteric pathogens were associated with diarrhea in HIV-1-infected case subjects in Peru, especially among those who were heterosexual. Clinical findings were poor predictors of detectable microbial etiology. The guidelines for initial management of chronic diarrhea with sulfamethoxazole-trimethoprim in HIV-1-infected persons require revision, at least in settings where prophylaxis with this agent is common.",
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AU - Weiss, Noel S.

AU - Gilman, Robert

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AU - Carrasco, Juan

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AU - Caballero, Martin

AU - Holmes, King K.

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N2 - Objective. We sought to determine the etiologies, manifestations, and risk factors for persistent (&7 days) diarrhea in human immunodeficiency virus type 1 (HIV-1)-infected persons in Peru. Design. The present study is a case-control study of 147 HIV-1-infected case subjects with persistent diarrhea and 147 HIV-1-infected control subjects without diarrhea. Methods. We obtained clinical, demographic, and exposure data, CD4 lymphocyte counts, and stool samples for detection of enteric parasitic and bacterial pathogens and rotavirus. Results: One or more enteric pathogen was identified in 55% of case subjects and 21% of control subjects (odds ratio adjusted for CD4 lymphocyte count, 3.8; 95% confidence interval, 2.2-6.5). The median CD4 lymphocyte count was highest with pathogen-free diarrhea and lowest with Cryptosporidium infection. Cryptosporidium species (the most frequent pathogen), Giardia lamblia, Aeromonas species, Campylobacter species, and rotavirus were all significantly associated with diarrhea. Bacterial pathogens were significantly associated with G. lamblia and rotavirus infection. Of the bacterial pathogens (Aeromonas, Campylobacter, Salmonella, and Vibrio species and enterotoxigenic Escherichia coli), only 24% were susceptible to cotrimoxazole, whereas 90% were susceptible to ciprofloxacin. In no case did the sensitivity or positive predictive value of specific clinical and laboratory findings for curable enteric infections exceed 50%. Conclusions. Several enteric pathogens were associated with diarrhea in HIV-1-infected case subjects in Peru, especially among those who were heterosexual. Clinical findings were poor predictors of detectable microbial etiology. The guidelines for initial management of chronic diarrhea with sulfamethoxazole-trimethoprim in HIV-1-infected persons require revision, at least in settings where prophylaxis with this agent is common.

AB - Objective. We sought to determine the etiologies, manifestations, and risk factors for persistent (&7 days) diarrhea in human immunodeficiency virus type 1 (HIV-1)-infected persons in Peru. Design. The present study is a case-control study of 147 HIV-1-infected case subjects with persistent diarrhea and 147 HIV-1-infected control subjects without diarrhea. Methods. We obtained clinical, demographic, and exposure data, CD4 lymphocyte counts, and stool samples for detection of enteric parasitic and bacterial pathogens and rotavirus. Results: One or more enteric pathogen was identified in 55% of case subjects and 21% of control subjects (odds ratio adjusted for CD4 lymphocyte count, 3.8; 95% confidence interval, 2.2-6.5). The median CD4 lymphocyte count was highest with pathogen-free diarrhea and lowest with Cryptosporidium infection. Cryptosporidium species (the most frequent pathogen), Giardia lamblia, Aeromonas species, Campylobacter species, and rotavirus were all significantly associated with diarrhea. Bacterial pathogens were significantly associated with G. lamblia and rotavirus infection. Of the bacterial pathogens (Aeromonas, Campylobacter, Salmonella, and Vibrio species and enterotoxigenic Escherichia coli), only 24% were susceptible to cotrimoxazole, whereas 90% were susceptible to ciprofloxacin. In no case did the sensitivity or positive predictive value of specific clinical and laboratory findings for curable enteric infections exceed 50%. Conclusions. Several enteric pathogens were associated with diarrhea in HIV-1-infected case subjects in Peru, especially among those who were heterosexual. Clinical findings were poor predictors of detectable microbial etiology. The guidelines for initial management of chronic diarrhea with sulfamethoxazole-trimethoprim in HIV-1-infected persons require revision, at least in settings where prophylaxis with this agent is common.

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