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

MARISSA L. BECKER 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

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CRAIG R. COHEN 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

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MARY CHEANG 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

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REYNOLD G. WASHINGTON 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

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JAMES F. BLANCHARD 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

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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

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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 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.

Author Notes

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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