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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 Presidents 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 dEtudes de Sarcome de Kaposi et Infections Opportunistes, 33 Harry Truman Boulevard, Cite de lExposition, 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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