title: Clostridium difficile infection in patients with HIV/AIDS.
abstract: Clostridium difficile infection (CDI) affects significant numbers of hospitalized patients and is an increasing problem in the community. It is also among the most commonly isolated pathogens in HIV patients with diarrheal illness and is ≥2 fold more common in HIV-seropositive individuals. This association is stronger in those with low absolute CD4 T cell counts or meeting clinical criteria for an AIDS diagnosis, and was most pronounced before the wide availability of highly active antiretroviral therapy. The presentation and outcome of CDI in HIV appears similar to the general population. The increased risk can in part be attributed to increased hospitalization and antimicrobial use, but HIV related alterations in fecal microbiota, gut mucosal integrity, and humoral and cell mediated immunity are also likely to play a role. Here we review the evidence for these observations and the relevance of recent advances in the diagnosis and management of CDI for the HIV clinician.
authors: Department of Infection and Immunity, The University of Sheffield Medical School & Sheffield Teaching Hospitals, Room LU108, L Floor, Beech Hill Road, Sheffield S10 2RX, UK. p.collini@sheffield.ac.uk
authors: Paul J
authors: PJ
authors: Collini
authors: Ed
authors: E
authors: Kuijper
authors: David H
authors: DH
authors: Dockrell
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D016360:Clostridioides difficile; D004761:Enterocolitis, Pseudomembranous / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D012307:Risk Factors
references: Blood. 2011 Sep 29;118(13):3499-503
references: 21778341
references: HIV Med. 2008 Nov;9(10):795-848
references: 18983477
references: JAMA. 2005 Dec 21;294(23):2989-95
references: 16414946
references: Lancet. 2011 Jan 1;377(9759):63-73
references: 21084111
references: Rev Clin Esp. 1996 Jul;196(7):424-30
references: 8804202
references: Infect Control Hosp Epidemiol. 2010 May;31(5):431-55
references: 20307191
references: Clin Diagn Lab Immunol. 1998 Jan;5(1):87-90
references: 9455887
references: Trends Immunol. 2009 Jul;30(7):334-43
references: 19540811
references: Infection. 2012 Dec;40(6):643-8
references: 22847629
references: Clin Infect Dis. 1998 Sep;27(3):487-93
references: 9770145
references: Nat Med. 2011 Nov 20;17(12):1585-93
references: 22101768
references: Gastroenterology. 1978 Nov;75(5):778-82
references: 700321
references: PLoS Pathog. 2011 Jun;7(6):e1002076
references: 21738466
references: Lancet Infect Dis. 2001 Sep;1(2):101-14
references: 11871461
references: Transpl Infect Dis. 2012 Dec;14(6):E161-5
references: 23121625
references: Clin Microbiol Infect. 2006 Oct;12 Suppl 6:2-18
references: 16965399
references: Infect Immun. 1998 Nov;66(11):5462-9
references: 9784558
references: Case Rep Infect Dis. 2012;2012:810943
references: 22593832
references: Gastroenterology. 1997 Mar;112(3):991-4
references: 9041262
references: Ann N Y Acad Sci. 2012 Jul;1258:19-24
references: 22731711
references: Curr HIV/AIDS Rep. 2012 Mar;9(1):44-51
references: 22193889
references: Cochrane Database Syst Rev. 2011 Sep 07;(9):CD004610
references: 21901692
references: Scand J Infect Dis. 2011 Jan;43(1):3-7
references: 20849366
references: Clin Infect Dis. 2010 Apr 1;50(7):953-62
references: 20180702
references: N Engl J Med. 2000 Feb 10;342(6):390-7
references: 10666429
references: Ann Surg. 2011 Sep;254(3):423-7; discussion 427-9
references: 21865943
references: Clin Infect Dis. 2012 Aug;55 Suppl 2:S132-42
references: 22752862
references: Cochrane Database Syst Rev. 2008 Jan 23;(1):CD004611
references: 18254055
references: N Engl J Med. 2011 Feb 3;364(5):422-31
references: 21288078
references: J Antimicrob Chemother. 2012 Mar;67(3):742-8
references: 22146873
references: J Infect. 2011 Sep;63(3):177-86
references: 21664932
references: J Infect. 1998 Sep;37(2):108-11
references: 9821082
references: Clin Microbiol Infect. 2001 Aug;7(8):421-7
references: 11591205
references: Am J Gastroenterol. 1993 Jun;88(6):891-7
references: 8503386
references: Am J Gastroenterol. 2007 Dec;102(12):2781-8
references: 17900327
references: Diagn Microbiol Infect Dis. 2002 Dec;44(4):325-30
references: 12543536
references: Clin Infect Dis. 1997 May;24(5):920-4
references: 9142793
references: Antimicrob Agents Chemother. 2011 Nov;55(11):5194-9
references: 21844318
references: Nat Immunol. 2006 Mar;7(3):302-10
references: 16429138
references: J Acquir Immune Defic Syndr. 2011 Aug 15;57(5):363-70
references: 21436711
references: Gastroenterology. 1994 Sep;107(3):858-63
references: 8076773
references: J Clin Microbiol. 2004 Sep;42(9):4316-8
references: 15365032
references: J Clin Gastroenterol. 1993 Apr;16(3):192-4
references: 8505488
references: Am J Infect Control. 2000 Jun;28(3):262-6
references: 10840348
references: J Infect. 2009 Jun;58(6):403-10
references: 19394704
references: Lancet. 1989 May 27;1(8648):1156-60
references: 2566734
references: J Biol Chem. 2002 Nov 1;277(44):42136-43
references: 12207012
references: Vaccine. 2012 Jun 19;30(29):4307-9
references: 22682287
references: J Pathog. 2012;2012:971958
references: 23326669
references: Clin Infect Dis. 1997 Nov;25(5):1230-2
references: 9402386
references: Clin Infect Dis. 2012 Aug;55 Suppl 2:S149-53
references: 22752864
references: Clin Microbiol Infect. 2009 Dec;15(12):1053-66
references: 19929972
references: Clin Infect Dis. 1997 Sep;25 Suppl 2:S204-5
references: 9310679
references: Clin Infect Dis. 2012 Aug;55 Suppl 2:S154-61
references: 22752865
references: N Engl J Med. 2013 Jan 31;368(5):407-15
references: 23323867
references: Infect Control Hosp Epidemiol. 2001 Jan;22(1):42-5
references: 11198022
references: Clin Microbiol Infect. 2009 Dec;15(12):1067-79
references: 19929973
references: Trans R Soc Trop Med Hyg. 2011 Nov;105(11):667-9
references: 21855100
references: N Engl J Med. 2010 Jan 21;362(3):197-205
references: 20089970
references: Am J Gastroenterol. 2012 Jan;107(1):89-95
references: 22108454
references: Am J Gastroenterol. 2001 Mar;96(3):766-72
references: 11280548
references: Ann Surg. 2002 Mar;235(3):363-72
references: 11882758
references: Int J Infect Dis. 2012 Sep;16(9):e677-9
references: 22771183
references: J Infect Dis. 1983 Jul;148(1):93-100
references: 6886489
references: J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Nov 1;16(3):176-81
references: 9390569
references: Proc Natl Acad Sci U S A. 2001 Aug 28;98(18):10362-7
references: 11504927
references: J Infect Dis. 2008 Feb 1;197(3):435-8
references: 18199029
references: Rev Infect Dis. 1984 Mar-Apr;6 Suppl 1:S235-41
references: 6718937
references: Clin Infect Dis. 2005 Dec 1;41(11):1621-7
references: 16267735
references: Am J Gastroenterol. 2012 Jun;107(6):922-31
references: 22472744
references: J Infect. 2012 Feb;64(2):131-47
references: 22178989
references: Br Med J. 1978 Mar 18;1(6114):695
references: 630301
references: J Hosp Infect. 2001 Jun;48(2):86-92
references: 11428873
references: Trans R Soc Trop Med Hyg. 2000 Mar-Apr;94(2):167-8
references: 10897357
references: Aliment Pharmacol Ther. 2012 Apr;35(8):865-75
references: 22360412
references: Clin Microbiol Infect. 2003 Aug;9(8):766-79
references: 14616696
references: Am J Gastroenterol. 1994 Aug;89(8):1226-9
references: 8053439
references: J Clin Gastroenterol. 2001 Jan;32(1):82-4
references: 11154179
references: J Acquir Immune Defic Syndr. 2002 Dec 15;31(5):542-3
references: 12473844
references: J Clin Microbiol. 2008 Feb;46(2):757-8
references: 18094140
references: J Med Microbiol. 2002 May;51(5):448-454
references: 11990498
references: N Engl J Med. 2004 Mar 4;350(10):e9
references: 14999125
references: AIDS. 1993 Nov;7(11):1441-7
references: 8280409
references: Arch Surg. 2007 Jul;142(7):624-31; discussion 631
references: 17638799
references: J Antimicrob Chemother. 1998 May;41 Suppl C:21-7
references: 9630371
references: J Biol Chem. 2003 Jan 24;278(4):2219-27
references: 12419805
references: Eur J Gastroenterol Hepatol. 1995 Mar;7(3):259-63
references: 7743309
references: Clin Gastroenterol Hepatol. 2011 Dec;9(12):1044-9
references: 21871249