title: Unexplained diarrhoea in HIV-1 infected individuals.
abstract: BACKGROUND
  Gastrointestinal symptoms, in particular diarrhoea, are common in non-treated HIV-1 infected individuals. Although various enteric pathogens have been implicated, the aetiology of diarrhoea remains unexplained in a large proportion of HIV-1 infected patients. Our aim is to identify the cause of diarrhoea for patients that remain negative in routine diagnostics.
  
  
  METHODS
  In this study stool samples of 196 HIV-1 infected persons, including 29 persons with diarrhoea, were examined for enteropathogens and HIV-1. A search for unknown and unexpected viruses was performed using virus discovery cDNA-AFLP combined with Roche-454 sequencing (VIDISCA-454).
  
  
  RESULTS
  HIV-1 RNA was detected in stool of 19 patients with diarrhoea (66%) compared to 75 patients (45%) without diarrhoea. In 19 of the 29 diarrhoea cases a known enteropathogen could be identified (66%). Next to these known causative agents, a range of recently identified viruses was identified via VIDISCA-454: cosavirus, Aichi virus, human gyrovirus, and non-A non-B hepatitis virus. Moreover, a novel virus was detected which was named immunodeficiency-associated stool virus (IASvirus). However, PCR based screening for these viruses showed that none of these novel viruses was associated with diarrhoea. Notably, among the 34% enteropathogen-negative cases, HIV-1 RNA shedding in stool was more frequently observed (80%) compared to enteropathogen-positive cases (47%), indicating that HIV-1 itself is the most likely candidate to be involved in diarrhoea.
  
  
  CONCLUSIONS
  Unexplained diarrhoea in HIV-1 infected patients is probably not caused by recently described or previously unknown pathogens, but it is more likely that HIV-1 itself plays a role in intestinal mucosal abnormalities which leads to diarrhoea.
authors.forename: Bas B
authors.initials: BB
authors.lastname: Oude Munnink
authors.forename: Marta
authors.initials: M
authors.lastname: Canuti
authors.forename: Martin
authors.initials: M
authors.lastname: Deijs
authors.forename: Michel
authors.initials: M
authors.lastname: de Vries
authors.forename: Maarten F
authors.initials: MF
authors.lastname: Jebbink
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Rebers
authors.forename: Richard
authors.initials: R
authors.lastname: Molenkamp
authors.forename: Formijn J
authors.initials: FJ
authors.lastname: van Hemert
authors.forename: Kevin
authors.initials: K
authors.lastname: Chung
authors.forename: Matthew
authors.initials: M
authors.lastname: Cotten
authors.forename: Fransje
authors.initials: F
authors.lastname: Snijders
authors.forename: Cees J A
authors.initials: CJ
authors.lastname: Sol
authors.affiliation: Laboratory of Experimental Virology, Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands. c.m.vanderhoek@amc.uva.nl.
authors.forename: Lia
authors.initials: L
authors.lastname: van der Hoek
mesh_terms: D000328:Adult; D054458:Amplified Fragment Length Polymorphism Analysis; D003967:Diarrhea / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D010849:Picornaviridae; D014780:Viruses / Q000302:isolation & purification*