Diarrhea, CD4 counts and enteric infections in a hospital - based cohort of HIV-infected patients around Varanasi, India.
BACKGROUND
As most of the studies in HIV patients with diarrhea were cross sectional, focusing on the etiological agents, we are reporting data on the rate of diarrhea, associations between diarrhea and CD4 counts and variation in frequency of identifying a pathogen with consistency of diarrhea and duration in a prospective hospital based study.


METHODS
Stool specimens were obtained between Jan 2001 and April 2003 from HIV infected adults with diarrhea presenting to Infectious Disease clinic, Banaras Hindu University, Varanasi. In all patients with diarrhea, specimens were examined by microscopy and cultures to identify pathogens.


RESULTS
During the study, 630 person years of observations with diarrhea were analyzed. 140 stool samples were collected representing 43% of episodes of reported diarrhea. Positivity of finding a pathogen from watery stools and formed stools were 40%&24% respectively (p < 0.01) probably due to associated inflammation is more in watery diarrhea. Patients having chronic diarrhea are 2.25 (95%CI 1.52-2.81) times at more risk of developing other opportunistic infections compared to those who don't have. However this is not true with the acute diarrhea where risk of harboring the opportunistic infections remain same.


CONCLUSIONS
Diarrhea was most strongly associated with low CD4 counts. Over two-thirds of diarrheal episodes were undiagnosed, suggesting that unidentified agents or primary HIV enteropathy are important causes of diarrhea in this population. There is a strong negative association between duration of diarrhea and CD4 levels.
Attili
Suresh V S
SV
Department of Medicine Institute of Medical Sciences, BHU, Varanasi-221005, India. sureshattili@yahoo.com
Gulati
A K
AK
Singh
V P
VP
Varma
D V
DV
Rai
M
M
Sundar
Shyam
S
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000382:microbiology; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004268:DNA-Binding Proteins; D003967:Diarrhea / Q000209:etiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012959:Socioeconomic Factors; D014764:Viral Proteins
D019380:Anti-HIV Agents; D004268:DNA-Binding Proteins; C091945:H5R protein, Vaccinia virus; D014764:Viral Proteins