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Am. J. Trop. Med. Hyg., 76(4), 2007, pp. 718-722
Copyright © 2007 by The American Society of Tropical Medicine and Hygiene

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DIARRHEAL DISEASE AMONG HIV-INFECTED ADULTS IN KARNATAKA, INDIA: EVALUATION OF RISK FACTORS AND ETIOLOGY

MARISSA L. BECKER*, CRAIG R. COHEN, MARY CHEANG, REYNOLD G. WASHINGTON, JAMES F. BLANCHARD, AND STEPHEN MOSES
Department of Medical Microbiology, Department of Community Health Sciences, and Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California; India-Canada Collaborative HIV/AIDS Project, Bangalore, India; St. John’s Medical College, Bangalore, India

The objectives of this study were to evaluate characteristics associated with diarrhea, the effect of trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis on diarrhea, the response to treatment with ciprofloxacin and tinidazole (Cipro-TZTM), and presence of enteric pathogens. Adults infected with human immunodeficiency virus with and without diarrhea served as cases and controls, respectively. Participants provided a medical history and underwent a physical examination. Blood was collected for CD4 cell counts and stool for culture. Cases were treated with Cipro-TZTM. Factors associated with a risk of diarrhea included crowded living and no toilet (all P < 0.05). Protective variables (P < 0.05) included a CD4 count greater than 200 cells/mm3 and TMP/SMX prophylaxis. Cases were more likely to have a pathogen identified (P = 0.05). Eighty-six percent of the cases responded to treatment. Important risk factors for diarrhea were identified. Protection by TMP/SMX reinforces the importance of prophylaxis. These data suggest that treatment with an antibiotic and anti-parasitic medication may be effective.

Received October 1, 2006. Accepted for publication January 15, 2007.

Acknowledgements: We thank the staff at the clinics who supported the study, especially Mr. K. Chandrashekaraiah for his enthusiasm and dedication. We also thank Dr. R. Macaden and Dr. G. D. Ravindran (St. John’s Medical College) for their assistance and support.

Financial support: This work was supported by a grant from the Canadian Institutes of Health Research Global Health Research Initiative. Marissa L. Becker is the recipient of a Canadian Institutes of Health Research (CIHR) fellowship award. Stephen Moses is the recipient of a CIHR investigator award. James F. Blanchard is supported by a Canada Research Chair in Epidemiology and Global Public Health Research.

* Address correspondence to Marissa L. Becker, Department of Medical Microbiology University of Manitoba, Room 543, Basic Medical Sciences Building 730 William Avenue, Winnipeg, Manitoba, Canada R3E 0W3. E-mail: beckerm{at}cc.umanitoba.ca

Authors’ addresses: Marissa L. Becker, Department of Medical Microbiology University of Manitoba, Room 543, Basic Medical Sciences Building 730 William Avenue, Winnipeg, Manitoba, Canada R3E 0W3, Telephone: 204-789-3312, Fax: 204-789-3926, E-mail: beckerm{at}cc.umanitoba.ca. Craig R. Cohen, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94143. Mary Cheang, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. Reynold G. Washington, India-Canada Collaborative HIV/AIDS Project (ICHAP), Bangalore, India, St. John’s Medical College, Bangalore, India, Department of Medicine, University of Manitoba, Winnipeg, Canada, and Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. James F. Blanchard, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada and India-Canada Collaborative HIV/AIDS Project (ICHAP), Bangalore, India. Stephen Moses, Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada and India-Canada Collaborative HIV/AIDS Project (ICHAP), Bangalore, India.

Reprint requests: Marissa L. Becker, Department of Medical Microbiology University of Manitoba, Room 543, Basic Medical Sciences Building 730 William Avenue, Winnipeg, Manitoba, Canada R3E 0W3.






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