Diarrhea in children less than two years of age with known HIV status in Kisumu, Kenya.
OBJECTIVE
To compare the frequency and etiology of diarrhea in children aged less than 2 years with known HIV status.


METHODS
This was a nested cohort study, whereby children were followed during monthly routine and unscheduled visits. The HIV status of children was determined with PCR. A stool culture was obtained from children with diarrhea. A subset of stool samples was examined for parasites and tested for rotavirus.


RESULTS
Between 1997 and 2001, 682 children (51.0% male) contributed observation periods with a mean of 47 weeks. Overall there were 198 episodes of diarrhea per 100 child-years of observation (CYO); diarrhea was more common among HIV-positive children than among HIV-negative children (321 vs. 183 episodes/100 CYO, respectively, p<0.01) and was not statistically different for HIV-negative children born to HIV-positive compared with HIV-negative mothers (182 vs. 187 episodes/100 CYO, respectively, p=0.36). For 66.5% of the acute episodes a stool culture was obtained; 27.8% of stool cultures yielded a bacterial pathogen. A positive stool culture was less likely among HIV-positive children compared to children of HIV-negative mothers (20.5% vs. 34.3%, p=0.01). Susceptibility of Salmonella and Shigella to commonly used antibiotics was low. Rotavirus was detected in 13.9% of 202 examined stool samples, and a stool parasite in 3.8% of 394 samples. Diarrhea was associated with 37.8% of child deaths.


CONCLUSIONS
Diarrhea was more common among HIV-infected children, but was not associated with specific bacterial pathogens. Measures that reduce diarrhea will benefit all children, but may benefit HIV-infected children in particular.
van Eijk
Anna M
AM
Department of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. amvaneijk@yahoo.com
Brooks
John T
JT
Adcock
Penny M
PM
Garrett
Valerie
V
Eberhard
Mark
M
Rosen
Daniel H
DH
Ayisi
John G
JG
Ochieng
John B
JB
Kumar
Lata
L
Gentsch
Jon R
JR
Nahlen
Bernard L
BL
Mintz
Eric D
ED
Slutsker
Laurence
L
D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D002675:Child, Preschool; D003967:Diarrhea / Q000150:complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D004405:Dysentery, Bacillary / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007630:Kenya / Q000453:epidemiology; D008297:Male; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000150:complications