title: Effect of human immunodeficiency virus infection on episodes of diarrhea among children in South Africa.
abstract: BACKGROUND
  Infection with HIV is increasing among children in South Africa. Diarrhea is a common cause of morbidity and mortality in Africa, and some studies have shown that HIV-infected children have episodes of severe diarrhea with higher mortality than HIV-uninfected children.
  
  
  OBJECTIVE
  To compare the severity, pathogens and outcome of diarrhea in HIV-infected and uninfected children.
  
  
  METHODS
  We studied 181 children ages 3 months to 4 years admitted for gastroenteritis to the Chris Hani Baragwanath Hospital in Soweto, South Africa. Demographic details of the children were recorded, as were the details of the episode of diarrhea. Stools specimens were collected and sent for microbiologic evaluation. The clinical course of the child's admission was recorded. Children were diagnosed as being infected with HIV if they tested positive by HIV enzyme-linked immunosorbent assay (ELISA) and were >15 months of age, or if they were ELISA-positive, were < 15 months of age and had clinical signs of HIV infection.
  
  
  RESULTS
  Of the 176 children with an HIV ELISA result, 31 (17.6%) were classified as HIV-infected. More HIV-infected children were malnourished (80.6% vs. 39.5%, P < 0.001) and more likely to have had prolonged diarrhea (16.1% vs. 5.9%, P = 0.07) compared with HIV-uninfected children. HIV-infected children had a higher rate of a codiagnosis of pneumonia (43.3% vs. 9.2%, P < 0.0001) and were more likely to require a hospital stay of >4 days (prevalence odds ratio, 5.11; 95% confidence interval, CI 1.49 to 17.52). There were no significant differences in stool pathogens or in the level of dehydration on admission between the HIV-infected and uninfected children.
  
  
  CONCLUSIONS
  HIV-infected children have the same spectrum of enteric pathogens as uninfected children but require more attention because of malnutrition and comorbidity.
authors.affiliation: Perinatal HIV Research Unit, University of the Witwatersrand, South Africa.
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.forename: W
authors.initials: W
authors.lastname: Hendson
authors.forename: H
authors.initials: H
authors.lastname: Crewe-Brown
authors.forename: L
authors.initials: L
authors.lastname: Dini
authors.forename: J
authors.initials: J
authors.lastname: Frean
authors.forename: O
authors.initials: O
authors.lastname: Perovic
authors.forename: E
authors.initials: E
authors.lastname: Vardas
mesh_terms: D001942:Breast Feeding; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology*; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D018023:HIV Seronegativity; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D009752:Nutritional Status; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology