Volume 76, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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-TZ™), 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-TZ™. Factors associated with a risk of diarrhea included crowded living and no toilet (all < 0.05). Protective variables ( < 0.05) included a CD4 count greater than 200 cells/mm and TMP/SMX prophylaxis. Cases were more likely to have a pathogen identified ( = 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.


Article metrics loading...

Loading full text...

Full text loading...



  1. Joint United Nations Programme on HIV/AIDS (UNAIDS), 2006. 2006 Report on the Global AIDS Epidemic. Geneva: UNAIDS.
  2. Cohen J, West AB, Bini EJ, 2001. Infectious diarrhea in human immunodeficiency virus. Gastroenterol Clin North Am 30 : 637–660.
  3. Mitra AK, Hernandez CD, Hernandez CA, Siddiq A, 2001. Management of diarrhoea in HIV-infected patients. Int J STD AIDS 12 : 630–639.
  4. Guerrant RL, Bobak DA, 2000. Nausea, vomiting and noninflammatory diarrhea. Mandell GL, ed. Principles and Practice of Infectious Disease. New York: Harcourt, 1098–1111.
  5. Guerrant RL, Hughes JM, Lima NL, Crane J, 1990. Diarrhea in developed and developing countries: magnitude, special settings and etiologies. Rev Infect Dis 12 (Suppl 1): S41–S50.
  6. Lew EA, Poles MA, Dietrich DT, 1997. Diarrheal diseases associated with HIV infection. Gastroenterol Clin North Am 26 : 259–290.
  7. Carcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J, Carrasco J, Seas C, Caballero M, Holmes KK, 2005. Etiologies and manifestations of persistent diarrhea in adults with HIV-1 infection: a case-control study in Lima, Peru. J Infcet Dis 191 : 11–19.
  8. Kartalija M, Sande MA, 1999. Diarrhea and AIDS in the era of highly active antiretroviral therapy. Clin Infect Dis 28 : 701–707.
  9. Lewthwaite P, Gill GV, Hart CA, Beeching NJ, 2005. Gastrointestinal parasites in the immunocompromised. Curr Opin Infect Dis 18 : 427–435.
  10. Vajpayee M, Kanswal S, Seth P, Wig N, 2003. Spectrum of opportunistic infections and profile of CD4 counts among AIDS patients in north India. Infection 31 : 336–340.
  11. Joshi M, Chowdhary AS, Dalal PJ, Maniar JK, 2002. Parasitic diarrhoea in patients with AIDS. Natl Med J India 15 : 72–74.
  12. Kumar SS, Ananthan S, Saravanan P, 2002. Role of coccidian parasites in causation of diarrhoea in HIV infected patients in Chennai. Indian J Med Res 116 : 85–89.
  13. Mohandas, Sehgal R, Sud A, Malla N, 2002. Prevalence of intestinal parasitic pathogens in HIV-seropositive individuals in northern India. Jpn J Infect Dis 55 : 83–84.
  14. Hayes C, Elliot E, Krales E, Downer G, 2003. Food and water safety for persons infected with human immunodeficiency virus. Clin Infect Dis 36 (Suppl 2): S106–S109.
  15. Nasinyama GW, McEwen SA, Wilson JB, Waltner-Toews D, Gyles CL, Opuda-Asibo J, 2000. Risk factors for acute diarrhoea among inhabitants of Kampala District, Uganda. S Afr Med J 90 : 891–898.
  16. Karnataka State AIDS Prevention Society (KSAPS), Government of Karnataka, and India-Canada Collaborative HIV/AIDS Project (ICHAP), 2004. Karnataka HIV Status Reports: Report on HIV Sentinel Surveillance. Bangalore: KSAPS & ICHAP, 2004.
  17. Weber R, Ledergerber B, Zbinden R, Altwegg M, Pfyffer GE, Spycher MA, Briner J, Kaiser L, Opravil M, Meyenberger C, Flepp M, 1999. Enteric infections and diarrhea in human immunodeficiency virus-infected persons: prospective community-based cohort study. Swiss HIV Cohort Study. Arch Intern Med 159 : 1473–1480.
  18. Call SA, Heudebert G, Saag M, Wilcox CM, 2000. The changing etiology of chronic diarrhea in HIV-infected patients with CD4 cell counts less than 200 cells/mm3. Am J Gastroenterol 95 : 3142–3146.
  19. Eisenberg JN, Wade TJ, Charles S, Vu M, Hubbard A, Wright CC, Levy D, Jensen P, Colford JM Jr, 2002. Risk factors in HIV-associated diarrhoeal disease: the role of drinking water, medication and immune status. Epidemiol Infect 128 : 73–81.
  20. Brink AK, Mahe C, Watera C, Lugada E, Gilks C, Whitworth J, French N, 2002. Diarrhoea, CD4 counts and enteric infections in a community-based cohort of HIV-infected adults in Uganda. J Infect 45 : 99–106.
  21. Lule JR, Mermin J, Ekwaru JP, Malamba S, Downing R, Ransom R, Nakanjako D, Wafula W, Hughes P, Bunnell R, Kaharuza F, Coutinho A, Kigozi A, Quick R, 2005. Effect of home based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda. Am J Trop Med Hyg 73 : 926–933.
  22. Mahmud MA, Hossain MM, Huang DB, Habib M, Dupont HL, 2001. Sociodemographic, environmental and clinical risk factors for developing persistent diarrhoea among infants in a rural community of Egypt. J Health Popul Nutr 19 : 313–319.
  23. Bern C, Kawai V, Vargas D, Rabke-Verani J, Williamson J, Chavez-Valdez R, Xiao L, Sulaiman I, Vivar A, Ticona E, Navincopa M, Cama V, Moura H, Secor WE, Visvesvara G, Gilman RH, 2005. The epidemiology of intestinal microsporidiosis in patients with HIV/AIDS in Lima, Peru. J Infect Dis 191 : 1658–1664.
  24. Datta D, Gazzard B, Stebbing J, 2003. The diagnostic yield of stool analysis in 525 HIV-1 infected individuals. AIDS 17 : 1711–1712.
  25. Mwachari CW, Meier AS, Muyodi J, Gatei W, Waiyaki P, Cohen CR, 2003. Chronic diarrhoea in HIV-1 infected adults in Nairobi, Kenya: evaluation of risk factors and the WHO treatment algorithm. AIDS 17 : 2124–2126.
  26. Certad G, Arenas-Pinto A, Pocaterra L, Ferrara G, Castro J, Bello A, Nunez L, 2003. Isosporiasis in Venezuelan adults infected with human immunodeficiency virus: clinical characterization. Am J Trop Med Hyg 69 : 217–222.
  27. World Health Organization (WHO), Global Programme on AIDS, 1991. Guidelines for the Clinical Management of HIV Infection in Adults. Geneva: World Health Organization. WHO/GPA/IDS/HCS/91.6.

Data & Media loading...

  • Received : 01 Oct 2006
  • Accepted : 15 Jan 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error