AJTMH Transactions of the Royal Society of Tropical Medicine and Hygiene
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Am. J. Trop. Med. Hyg., 80(6), 2009, pp. 1060-1064
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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High Early Mortality in Patients with Chronic Acquired Immunodeficiency Syndrome Diarrhea Initiating Antiretroviral Therapy in Haiti: A Case-Control Study

Rebecca A. Dillingham*, Relana Pinkerton, Paul Leger, Patrice Severe, Richard L. Guerrant, J. William Pape, AND Daniel W. Fitzgerald
University of Virginia, Charlottesville, Virginia; Groupe Haitien d’Etudes de Sarcome de Kaposi et Infections Opportunistes, Port au Prince, Haiti; Weill Cornell Medical College, New York, New York

This case-control study examines whether chronic diarrhea at initiation of antiretroviral therapy (ART) affects survival of human immunodefiency virus–infected patients. Cases (288) were treatment-naive, non-pregnant, adults with self report of frequent loose stool for > 3 weeks at the time ART was initiated. One-third of patients had an enteric pathogen identified including Cryptosporidium spp., Giardia spp., Isospora belli, Cyclospora cayetanensis, and Entamoeba histolytica. Control patients (400) did not have diarrhea when initiating ART. At six weeks, mortality was 10% in the patients with diarrhea and 5% in the patients without diarrhea (P = 0.009). Chronic diarrhea in patients requesting ART in Haiti is associated with increased early mortality.

Received June 17, 2008. Accepted for publication February 15, 2009.

Financial support: This study was supported by University of Virginia infectious disease and biodefense training grant, 5T32AI007046-31; by Fogarty International Center grants TW 00018, TW006896, and TW006901; and National Institute of Allergy and Infectious Diseases grants AI058257 and A1077339-01A1. Clinical care of the patients in this cohort was supported by grants from the Global Fund Against AIDS, Malaria, and Tuberculosis and the President’s Emergency Plan for AIDS Relief. The funders had no role in the design, conduct, or reporting of this study or in the decision to publish its results.

* Address correspondence to Rebecca A. Dillingham, Box 801379, Charlottesville, VA 22903. E-mail: rd8v{at}virginia.edu

Authors’ addresses: Rebecca A. Dillingham, Relana Pinkerton, and Richard L. Guerrant, PO Box 801379, University of Virginia, Charlottesville, VA 22908. Paul Leger, Patrice Severe, and J. William Pape, Groupe Haitien d’Etudes de Sarcome de Kaposi et Infections Opportunistes, 33 Harry Truman Boulevard, Cite de l’Exposition, Port au Prince 6116, Haiti. Daniel W. Fitzgerald, Weill Cornell Medical College, A-431, 1300 York Avenue, New York, NY 10021.






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Copyright © 2009 by the American Society of Tropical Medicine and Hygiene.