title: Clostridium difficile infections in HIV-positive patients with diarrhoea.
abstract: BACKGROUND
  Patients with HIV/AIDS are at a high risk of being infected with toxin-producing strains of Clostridium difficile (C. difficile) because of frequent hospitalization, exposure to antibiotics and antibiotic prophylaxis for opportunistic infections. There are little data from India on the prevalence of C. difficile infection in such patients.
  
  
  METHODS
  We assessed the occurrence of C. difficile infections in HIV-positive patients with diarrhoea by looking for the presence of its toxin as well as by culturing. Enzyme immunoassay (EIA, Premier toxins A and B; Meridian Diagnostic Inc.) was used to detect toxin from 237 fresh stool samples collected from HIV-positive patients with diarrhoea. Culture was done on cycloserine-cefoxitin-fructose agar and brain- heart infusion agar.
  
  
  RESULTS
  C. difficile was found in 12 of 237 (5.1%, 95% CI 2.64%-8.68%) HIV-positive patients with diarrhoea (9 patients were positive by EIA and 3 by culture). The presence of C. difficile in patients who had received antiretroviral therapy (7/66 [10.6%]) was significantly higher (p < 0.016) compared with those who had not (5/171 [3%]). Of the 12 patients positive for C. difficile, 7 were on antiretroviral therapy for a mean (SD) of 34.4 months with mean CD4+ count of 186 (98.81) cells/cmm and 5 patients were anti-retroviral-naïve with mean CD4+ count of 181 (68.7) cells/cmm. All the 12 patients were on antibiotics for previous 2 months and 4 of 12 had been hospitalized in the previous 30 days.
  
  
  CONCLUSIONS
  C. difficile infections occurred more frequently in patients who had received antiretroviral therapy. Our study population had a lower frequency of C. difficile infections compared to previous studies.
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Medicine.
authors: N
authors: N
authors: Kumar
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Medicine.
authors: M
authors: M
authors: Ekka
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Medicine.
authors: Raghunandan
authors: R
authors: P
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Medicine.
authors: S
authors: S
authors: Ranjan
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Medicine.
authors: S
authors: S
authors: Sinha
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Medicine.
authors: S K
authors: SK
authors: Sharma
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Microbiology.
authors: R
authors: R
authors: Chaudhry
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Microbiology.
authors: N
authors: N
authors: Sharma
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Microbiology.
authors: H
authors: H
authors: Ahmad
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Microbiology.
authors: J C
authors: JC
authors: Samantaray
authors: All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, Department of Biostatistics.
authors: V
authors: V
authors: Sreenivas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification; D060085:Coinfection / Q000453:epidemiology / Q000517:prevention & control; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents