Enteric viral infections as a cause of diarrhoea in the acquired immunodeficiency syndrome.
OBJECTIVE
The role of non-cytomegalovirus (CMV) enteric viral infection in causing diarrhoea in patients with human immunodeficiency virus (HIV) is poorly understood. We aimed to investigate the prevalence of these infections in acute and chronic diarrhoea.


METHODS
Stool specimens from 377 HIV-infected patients presenting with diarrhoea were studied prospectively for evidence of non-CMV enteric viral infection. Patients with diarrhoea underwent investigation for gastrointestinal pathogens, including electron microscopic examination of stool for enteric viruses. We collected data on patients in whom enteric virus was identified and examined the association of enteric virus infection with diarrhoeal symptomatology.


RESULTS
Eighty-nine (10.3%) stool specimens from 60 (15.9%) HIV+ individuals were positive for coronavirus (n = 13, 22%), rotavirus (n = 11, 18%), adenovirus (n = 30, 50%) and small round structured viruses (n = 5, 8%) or dual infection (n = 2, 3%). Thirty-four of 52 (65%) patients available for analysis had acute diarrhoea, and 18/52 (35%) had chronic diarrhoea. Twenty-three of 52 (44%) patients had a concurrent gut pathogen. After exclusion of concurrent pathogens enteric viral infections were found to be significantly associated with acute as opposed to chronic diarrhoea (P = 0.004). The presence of adenovirus colitis was significantly more likely to be associated with chronic diarrhoea (15/21 cases) than adenovirus isolated from stool alone (9/23 cases) (P = 0.03). There was a trend towards an association between adenovirus colitis and colonic cytomegalovirus infection (P = 0.06).


CONCLUSIONS
Enteric viral infection is strongly associated with acute diarrhoea in patients with HIV. Light microscopic examination of large bowel biopsies can identify adenovirus colitis which is significantly associated with chronic diarrhoea, and in addition may facilitate gastrointestinal co-infection with CMV.
Thomas
P D
PD
Department of HIV/GUM Medicine, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
Pollok
R C
RC
Gazzard
B G
BG
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D000208:Acute Disease; D000328:Adult; D002908:Chronic Disease; D003967:Diarrhea / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D019053:HIV Enteropathy / Q000150:complications / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D006113:United Kingdom / Q000453:epidemiology