Unexplained diarrhoea in HIV-1 infected individuals

Oude Munnink, Bas B; Canuti, Marta; Deijs, Martin; de Vries, Michel; Jebbink, Maarten F; Rebers, Sjoerd; Molenkamp, Richard; van Hemert, Formijn J; Chung, Kevin; Cotten, Matthew; Snijders, Fransje; Sol, Cees JA; van der Hoek, Lia

The role of HIV-1 itself in the unexplained diarrhoea was also examined. HIV-1 RNA was detectable in stool of 19 patients with diarrhoea (66%) compared to 75 patients without diarrhoea (45%). This association was not significant (p value: 0.06). It could be that HIV-1 shedding is just a sign of infection by pathogens, and that shedding of the virus occurs in case an enteropathogen disrupts the mucosal barrier. However, unexpectedly, in the group without enteropathogens the frequency of HIV-1 RNA detection in stool was higher (8 out of 10, 80%) compared to the group where an enteropathogen could be found (9 out of 19, 47%), thus even an inverse relationship between HIV-1 shedding and infection by known pathogens was measured. Finally, we could exclude that the use of antibiotics or other treatment was the cause of diarrhoea. In total 91 patients were treated with antibiotics, most of them with a combination of sulfamethoxazole and trimethoprim and there was no difference in antibiotic usage in diarrhoea cases compared to the control patients without diarrhoea (41% versus 49%).