title: Aetiology of diarrhoea among persons with HIV and their family members in rural Uganda: a community-based study.
abstract: OBJECTIVE
  To identify pathogens associated with diarrhoea in HIV-infected persons and their HIV-uninfected family members.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Rural community in eastern Uganda.
  
  
  METHODS
  Eight hundred and seventy nine HIV-infected adults (74% females and median age 35 years (IQR, 29-41) and 2771 HIV-uninfected family members (51% females and median age 11 years (IQR 6-16) were included.
  
  
  METHODS
  Using microscopy and culture, stools were tested for parasites, bacteria and bacterial-antimicrobial-susceptibility. Logistic regression models, adjusting for age, CD4 cells, season, household clustering and use of safe-water system were used for relationships between pathogens, diarrhoea and HIV.
  
  
  RESULTS
  Persons with HIV had similar pathogens in diarrhoeal (69%) and nondiarrhoeal stools (57%). Most diarrhoea was not associated with identifiable aetiology; the population attributable risk of diarrhoea for known diarrhoea pathogens was 32%. Enteric bacteria (19%), enteropathogenic or enterotoxigenic E. coli (8%), Aeromonas species (7%), Strongyloides stercoralis (8%) and Cryptosporidium parvum (5%). HIV-infected, stools had more Cryptosporidium parvum than HIV-uninfected (OR 2.64, 95% CI 1.43-4.87). Most bacteria were resistant to commonly used antimicrobials irrespective of HIV status.
  
  
  CONCLUSIONS
  Irrespective of HIV-status, aetiologies of majority of their diarrhoea in Uganda cannot be identified by microscopy and culture. Bacterial pathogens isolated have high resistance to common antimicrobials. Empiric treatment should be tailored to local bacterial-resistance patterns.
authors.affiliation: CDC-Uganda, Global AIDS Program, National Center for HIV, STD and TB Prevention, Centers for Disease Control and Prevention Uganda, Uganda Virus Research Institute, Entebbe.
authors.forename: J R
authors.initials: JR
authors.lastname: Lule
authors.forename: J
authors.initials: J
authors.lastname: Mermin
authors.forename: A
authors.initials: A
authors.lastname: Awor
authors.forename: P
authors.initials: P
authors.lastname: Hughes
authors.forename: A
authors.initials: A
authors.lastname: Kigozi
authors.forename: W
authors.initials: W
authors.lastname: Wafula
authors.forename: D
authors.initials: D
authors.lastname: Nakanjako
authors.forename: F
authors.initials: F
authors.lastname: Kaharuza
authors.forename: R
authors.initials: R
authors.lastname: Downing
authors.forename: R
authors.initials: R
authors.lastname: Quick
mesh_terms: D000328:Adult; D003967:Diarrhea / Q000382:microbiology* / Q000469:parasitology*; D005243:Feces / Q000382:microbiology / Q000469:parasitology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012424:Rural Population; D014454:Uganda