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

One of the most affected sites in untreated human immunodeficiency virus (HIV)-infected persons is the gastrointestinal tract [1] [2] [3] [4] [5] . In these patients diarrhoea occurs frequently, especially in HIV-1 patients who are not treated with anti-retroviral therapy. Routine diagnostics in fecal samples often remain negative, despite the sensitive diagnostic assays which are now available. In this study our aim is to identify the cause of diarrhoea for patients in which no enteropathogen could be found. There are several possible explanations why these patients remain negative in routine diagnostics: First, HIV-1 itself might play a role. HIV-1 infected mucosal cells have been observed in HIV-1 infected persons [6] [7] [8] [9] [10] [11] and enterocytes exposed to HIV-1 show altered function and proliferation [12, 13] . However, it has not been demonstrated that HIV-1 causes diarrhoea. Secondly, there are several recent reports describing novel viral agents which are found in stool that could play a role in diarrhoea (see below), and these agents are not yet included in routine diagnostics.