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

Since the gastrointestinal tract is one of the most affected sites in untreated HIV-1 infections, the cause of diarrhoea in HIV-1 infected individuals was sought. After testing for all known enteropathogens, a pathogenic agent was detected in 66% of the diarrhoea cases. Virus infection accounted for 54% of the diarrhoea cases, bacterial infection was identified in 17%, parasitic infection in 21% and also some dual infections were observed. Of all viruses, norovirus accounts for the majority of infections (34%), followed by sapovirus and enterovirus (10% each). Still, in 34% of the patients with diarrhoea the causative agent could not be found. A careful investigation of the cause of unexplained diarrhoea in these 10 patients was performed using deep sequencing strategies. We were able to identify several recently described and one new virus with VIDISCA-454 (e.g. NANBH virus, cosavirus, Aichi virus, human gyrovirus and a novel IAS virus). However, no association between these viruses and diarrhoea was observed.