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

Rebecca A. Dillingham 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

Search for other papers by Rebecca A. Dillingham in
Current site
Google Scholar
PubMed
Close
,
Relana Pinkerton 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

Search for other papers by Relana Pinkerton in
Current site
Google Scholar
PubMed
Close
,
Paul Leger 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

Search for other papers by Paul Leger in
Current site
Google Scholar
PubMed
Close
,
Patrice Severe 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

Search for other papers by Patrice Severe in
Current site
Google Scholar
PubMed
Close
,
Richard L. Guerrant 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

Search for other papers by Richard L. Guerrant in
Current site
Google Scholar
PubMed
Close
,
J. William Pape 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

Search for other papers by J. William Pape in
Current site
Google Scholar
PubMed
Close
, 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

Search for other papers by Daniel W. Fitzgerald in
Current site
Google Scholar
PubMed
Close
Restricted access

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.

Author Notes

  • 1

    Boncy M, Laroche AC, Liautaud B, Mathurin JR, Pape JW, Pamphile M, Péan V, St-Amand MM, Thomas F, Arnoux E, Elie R, Guérin JM, Laroche AC, Maelbranche R, Pierre G, 1983. Acquired immunodeficiency in Haitians. N Engl J Med 308 :1419–1420.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Brink A-K, 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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Carcamo C, Hooton T, Wener MH, Weiss NS, Gilman R, Arevalo J, Carrasco J, Seas, 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 Infect Dis 191 :11–19.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Dallabetta GA, Miotti PG, 1992. Chronic diarrhoea in AIDS patients in the tropics: a review. Trop Doct 22 :3–9.

  • 5

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Serwadda D, Mugerwa RD, Sewankambo NK, Lwegaba A, Carswell JW, Kirya GB, Bayley AC, Downing RG, Tedder RS, Clayden SA, 1985. Slim disease: a new disease in Uganda and its association with HTLV-III infection. Lancet 2 :849–852.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Chakraborty N, Mukherjee A, Santra S, Sarkar RN, Banerjee D, Guha SK, Chakraborty S, Bhattacharyya SK, 2008. Current trends of opportunistic infections among HIV-seropositive patients from Eastern India. Jpn J Infect Dis 61 :49–53.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Gupta S, Narang S, Nunavath V, Singh S, 2008. Chronic diarrhoea in HIV patients: prevalence of coccidian parasites. Indian J Med Microbiol 26 :172–175.

  • 9

    Akolo C, Ukoli CO, Ladep GN, Idoko JA, 2008. The clinical features of HIV/AIDS at presentation at the Jos University Teaching Hospital. Niger J Med 17 :83–87.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Lavy V, 2007. Presenting symptoms and signs in children referred for palliative care in Malawi. Palliat Med 21 :333–339.

  • 11

    Ferrand RA, Luethy R, Bwakura F, Mujuru H, Miller RF, Corbett EL, 2007. HIV infection presenting in older children and adolescents: a case series from Harare, Zimbabwe. Clin Infect Dis 44 :874–878.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    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.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Lindan CP, Allen S, Serufilira A, Lifson AR, Van de Perre P, Chen-Rundle A, Batungwanayo J, Nsengumuremyi F, Bogaerts J, Hulley S, 1992. Predictors of mortality among HIV-infected women in Kigali, Rwanda. Ann Intern Med 116 :320–328.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Maggi P, Larocca AM, Quarto M, Serio G, Brandonisio O, Angarano G, Pastore G, 2000. Effect of antiretroviral therapy on cryptosporidiosis and microsporidiosis in patients infected with human immunodeficiency virus type 1. Eur J Clin Microbiol Infect Dis 19 :213–217.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Carr A, Marriott D, Field A, Vasak E, Cooper DA, 1998. Treatment of HIV-1-associated microsporidiosis and cryptosporidiosis with combination antiretroviral therapy. Lancet 351 :256–261.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, Miotti P, Wood R, Laurent C, Sprinz E, Seyler C, Bangsberg DR, Balestre E, Sterne JA, May M, Egger M; Antiretriviral Therapy in Lower Incomes Countries (ART-LINC) Collaboration; ART Cohort Collaboration (ART-CC) groups, 2006. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 367 :817–824.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Ferradini L, Jeannin A, Pinoges L, Izopet J, Odhiambo D, Mankhambo L, Karungi G, Szumilin E, Balandine S, Fedida G, Carrieri MP, Spire B, Ford N, Tassie JM, Guerin PJ, Brasher C, 2006. Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment. Lancet 367 :1335–1342.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Lawn SD, Myer L, Orrell C, Bekker LG, Wood R, 2005. Early mortality among adults accessing a community-based antiretroviral service in South Africa: implications for programme design. AIDS 19 :2141–2148.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Lawn SD, Harries AD, Anglaret X, Myer L, Wood R, 2008. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS 22 :1897–1908.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Coetzee D, Hildebrand K, Boulle A, Maartens G, Louis F, Labatala V, Reuter H, Ntwana N, Goemaere E, 2004. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS 18 :887–895.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Etard JF, Ndiaye I, Thierry-Mieg M, Gueye NF, Gueye PM, Laniece I, Dieng AB, Diouf A, Laurent C, Mboup S, Sow PS, Delaporte E, 2006. Mortality and causes of death in adults receiving highly active antiretroviral therapy in Senegal: a 7-year cohort study. AIDS 20 :1181–1189.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Jerene D, Endale A, Hailu Y, Lindtjorn B, 2006. Predictors of early death in a cohort of Ethiopian patients treated with HAART. BMC Infect Dis 6 :136.

  • 23

    Brantley RK, Williams KR, Silva TM, Sistrom M, Thielman NM, Ward H, Lima AA, Guerrant RL, 2003. AIDS-associated diarrhea and wasting in northeast Brazil is associated with subtherapeutic plasma levels of antiretroviral medications and with both bovine and human subtypes of Cryptosporidium parvum. Braz J Infect Dis 7 :16–22.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Bushen OY, Davenport JA, Lima AB, Piscitelli SC, Uzgiris AJ, Silva TM, Leite R, Kosek M, Dillingham RA, Girao A, Lima AA, Guerrant RL, 2004. Diarrhea and reduced levels of antiretroviral drugs: improvement with glutamine or alanyl-glutamine in a randomized controlled trial in northeast Brazil. Clin Infect Dis 38 :1764–1770.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Pinheiro VG, Ramos LM, Monteiro HS, Barroso EC, Bushen OY, Facanha MC, Peloquin CA, Guerrant RL, Lima AA, 2006. Intestinal permeability and malabsorption of rifampin and isoniazid in active pulmonary tuberculosis. Braz J Infect Dis 10 :374–379.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Macnab KA, Gill MJ, Sutherland LR, De Boer Visser N, Church D, 1993. Erratic zidovudine bioavailability in HIV seropositive patients. J Antimicrob Chemother 31 :421–428.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Murphy B, Taylor C, Crane R, Okong P, Bjarnason I, 1999. Comparison of intestinal function in human immunodeficiency virus-seropositive patients in Kampala and London. Scand J Gastroenterol 34 :491–495.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Gurumurthy P, Ramachandran G, Kumar A, Rajasekaran S, Padmapriyaarsini C, Swaminathan S, Venkatesan P, Sekar L, Kumar S, Krishnarajasekhar OR, Paramesh P, 2004. Malabsorption of rifampin and isoniazid in HIV-infected patients with and without tuberculosis. Clin Infect Dis 38 :280–283.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Paton NI, Sangeetha S, Earnest A, Bellamy R, 2006. The impact of malnutrition on survival and the CD4 count response in HIV-infected patients starting antiretroviral therapy. HIV Med 7 :323–330.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Severe P, Leger P, Charles M, Noel F, Bonhomme G, Bois G, George E, Kenel-Pierre S, Wright PF, Gulick R, Johnson WD Jr, Pane JW, Fitzgerald DW, 2005. Antiretroviral therapy in a thousand patients with AIDS in Haiti. N Engl J Med 353 :2325–2334.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Tang AM, Forrester J, Spiegelman D, Knox TA, Tchetgen E, Gorbach SL, 2002. Weight loss and survival in HIV-positive patients in the era of highly active antiretroviral therapy. J Acquir Immune Defic Syndr 31 :230–236.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    DeHovitz JA, Pape JW, Boncy M, Johnson WD Jr, 1986. Clinical manifestations and therapy of Isospora belli infection in patients with the acquired immunodeficiency syndrome. N Engl J Med 315 :87–90.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Verdier RI, Fitzgerald DW, Johnson WD Jr, Pape JW, 2000. Trimethoprim-sulfamethoxazole compared with ciprofloxacin for treatment and prophylaxis of Isospora belli and Cyclospora cayetanensis infection in HIV-infected patients. A randomized, controlled trial. Ann Intern Med 132 :885–888.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Pape JW, Liautaud B, Thomas F, Mathurin JR, St Amand MM, Boncy M, Pean V, Pamphile M, Larouche AC, Johnson WD Jr, 1983. Characteristics of the acquired immunodeficiency syndrome (AIDS) in Haiti. N Engl J Med 309 :945–950.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 867 813 19
Full Text Views 241 7 0
PDF Downloads 57 10 2
 

 

 

 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save