Clinical Features of Human Immunodeficiency Virus–Infected Patients Presenting with Cholera in Port-au-Prince, Haiti

Karine Sévère Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.

Search for other papers by Karine Sévère in
Current site
Google Scholar
PubMed
Close
,
Stravinsky B. Anglade Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.

Search for other papers by Stravinsky B. Anglade in
Current site
Google Scholar
PubMed
Close
,
Claudin Bertil Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.

Search for other papers by Claudin Bertil in
Current site
Google Scholar
PubMed
Close
,
Aynsley Duncan Center for Global Health, Weill Cornell Medical College, New York, New York.

Search for other papers by Aynsley Duncan in
Current site
Google Scholar
PubMed
Close
,
Patrice Joseph Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.

Search for other papers by Patrice Joseph in
Current site
Google Scholar
PubMed
Close
,
Alexandra Deroncenay Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.

Search for other papers by Alexandra Deroncenay in
Current site
Google Scholar
PubMed
Close
,
Marie M. Mabou Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.

Search for other papers by Marie M. Mabou in
Current site
Google Scholar
PubMed
Close
,
Oksana Ocheretina Center for Global Health, Weill Cornell Medical College, New York, New York.

Search for other papers by Oksana Ocheretina in
Current site
Google Scholar
PubMed
Close
,
Lindsey Reif Center for Global Health, Weill Cornell Medical College, New York, New York.

Search for other papers by Lindsey Reif in
Current site
Google Scholar
PubMed
Close
,
Grace Seo Center for Global Health, Weill Cornell Medical College, New York, New York.

Search for other papers by Grace Seo in
Current site
Google Scholar
PubMed
Close
,
Jean W. Pape Groupe Haïtien Etude pour le Sarcome de Kaposi et les Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti.
Center for Global Health, Weill Cornell Medical College, New York, New York.

Search for other papers by Jean W. Pape in
Current site
Google Scholar
PubMed
Close
, and
Daniel W. Fitzgerald Center for Global Health, 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

Human immunodeficiency virus (HIV) infection has been postulated to alter the natural history of cholera, including increased susceptibility to infection, severity of illness, and chronic carriage of Vibrio cholerae. Haiti has a generalized HIV epidemic with an adult HIV prevalence of 1.9% and recently suffered a cholera epidemic. We conducted a prospective study at the cholera treatment center (CTC) of GHESKIO in Haiti to characterize the coinfection. Adults admitted at the CTC for acute diarrhea were invited to participate in the study. Vital signs, frequency, and volume of stools and/or vomiting were monitored, and single-dose doxycycline was administered. After counseling, participants were screened for HIV by enzyme-linked immunosorbent assay and for cholera by culture. Of 729 adults admitted to the CTC, 99 (13.6%) had HIV infection, and 457 (63%) had culture-confirmed cholera. HIV prevalence was three times higher in patients without cholera (23%, 63/272) than in those with culture-confirmed cholera (7.9%, 36/457). HIV prevalence in patients with culture-confirmed cholera (7.9%) was four times higher than the adult prevalence in Port-au-Prince (1.9%). Of the 36 HIV-infected patients with cholera, 25 (69%) had moderate/severe dehydration versus 302/421 (72%) in the HIV negative. Of 30 HIV-infected patients with weekly stool cultures performed after discharge, 29 (97%) were negative at week 1. Of 50 HIV-negative patients with weekly stool cultures, 49 (98%) were negative at week 1. In countries with endemic HIV infection, clinicians should consider screening patients presenting with suspected cholera for HIV coinfection.

Author Notes

* Address correspondence to Grace Seo, Center for Global Health, Weill Cornell Medical College, 402 East 67th Street, 2nd Floor, New York, NY 10065. E-mail: grs2013@med.cornell.edu

Authors' addresses: Karine Sévère, Stravinsky B. Anglade, Claudin Bertil, and Alexandra Deroncenay, Infectious Diseases, Les Centres GHESKIO, Port-au-Prince, Haiti, E-mails: karinesevere@gheskio.org, sanglade@gheskio.org, claudinbertil@gmail.com, and aderoncenay@gmail.com. Aynsley Duncan, Oksana Ocheretina, Lindsey Reif, Grace Seo, Jean W. Pape, and Daniel W. Fitzgerald, Center for Global Health, Joan and Sanford I Weill Medical College of Cornell University, New York, NY, E-mails: ayd2001@med.cornell.edu, oko2001@med.cornell.edu, lir2020@med.cornell.edu, grs2013@med.cornell.edu, jwpape@gheskio.org, and dwf2001@med.cornell.edu. Patrice Joseph and Marie M. Mabou, Les Centres GHESKIO, Port-au-Prince, Haiti, E-mails: pjoseph@gheskio.org and mmabou@gheskio.org.

  • 1.

    Mintz ED, Tauxe RV, 2013. Cholera in Africa: a closer look and a time for action. J Infect Dis 208 (Suppl 1): S4S7.

  • 2.

    Luquero FJ, Grout L, Ciglenecki I, Sakoba K, Traore B, Heile M, Dialo AA, Itama C, Serafini M, Legros D, Grais RF, 2013. First outbreak response using an oral cholera vaccine in Africa: vaccine coverage, acceptability and surveillance of adverse events, Guinea, 2012. PLoS Negl Trop Dis 7: e2465.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Djomassi LD, Gessner BD, Andze GO, Mballa GA, 2013. National surveillance data on the epidemiology of cholera in Cameroon. J Infect Dis 208 (Suppl 1): S92S97.

  • 4.

    Jenson D, Szabo V, Duke FHI Haiti Humanities Laboratory Student Research Team, 2011. Cholera in Haiti and other Caribbean regions, 19th century. Emerg Infect Dis 17: 21302135.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Ivers LC, Walton DA, 2012. The “first” case of cholera in Haiti: lessons for global health. Am J Trop Med Hyg 86: 3638.

  • 6.

    Weil AA, Ivers LC, Harris JB, 2012. Cholera: lessons from Haiti and beyond. Curr Infect Dis Rep 14: 18.

  • 7.

    UNAIDS, 2013. September 2013 Core Epidemiology Slides: Global Summary of the AIDS Epidemic 2012. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/201309_epi_core_en.pdf. Accessed September 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    UNAIDS, 2013. Global Report: UNAIDS Report on the Global AIDS Epidemic 2013. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiology/2013/gr2013/UNAIDS_Global_Report_2013_en.pdf. Accessed November 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Cayemittes M, Busangu MF, Bizimana JDD, Cayemittes V, Charles E, 2012. Enquête Mortalité, Morbidité et Utilisation des Services HAÏTI 2012. Available at: http://mspp.gouv.ht/site/downloads/EMMUSVdocumentfinal.pdf. Accessed November 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Ministère de la Santè Publique et de la Population, 2014. Rapport Journalier du MSPP. Available at: http://mspp.gouv.ht/site/downloads/Rapport%20Web_16.03_Avec_Courbes_Departementales.pdf. Accessed November 2015.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB, 2012. Cholera. Lancet 379: 24662476.

  • 12.

    Sack DA, Sack RB, Nair GB, Siddique A, 2004. Cholera. Lancet 363: 223233.

  • 13.

    von Seidlein L, Wang XY, Macuamule A, Mondlane C, Puri M, Hendriksen I, Deen JL, Chaignat CL, Clemens JD, Ansaruzzaman M, Barreto A, Songane FF, Lucas M, 2008. Is HIV infection associated with an increased risk for cholera? Findings from a case-control study in Mozambique. Trop Med Int Health 13: 683688.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Rey J, Milleliri JM, Soares JL, Boutin JP, Desfontaine M, Merouze F, Van de Perre P, 1995. HIV seropositivity and cholera in refugee children from Rwanda. AIDS 9: 12031204.

  • 15.

    Utsalo SJ, Eko FO, Umoh F, Asindi AA, 1999. Faecal excretion of Vibrio cholerae during convalescence of cholera patients in Calabar, Nigeria. Eur J Epidemiol 15: 379381.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    World Health Organization, 2015. Cholera. Available at: http://www.who.int/mediacentre/factsheets/fs107/en/index.html. Accessed September 2015.

  • 17.

    World Health Organization, 2004. First Steps for Managing an Outbreak of Acute Diarrhoea. Available at: http://www.who.int/topics/cholera/publications/en/first_steps.pdf. Accessed September 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Baron EJ, Miller JM, Weinstein MP, Richter SS, Gilligan PH, Thomson RB Jr, Bourbeau P, Carroll KC, Kehl SC, Dunne WM, Robinson-Dunn B, Schwartzman JD, Chapin KC, Snyder JW, Forbes BA, Patel R, Rosenblatt JE, Pritt BS, 2013. A guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis 57: e22e121.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Mushayabasa S, Bhunu CP, 2012. Is HIV infection associated with an increased risk for cholera? Insights from a mathematical model. Biosystems 109: 203213.

  • 20.

    Valcin CL, Severe K, Riche CT, Anglade BS, Moise CG, Woodworth M, Charles M, Li Z, Joseph P, Pape JW, Wright PF, 2013. Predictors of disease severity in patients admitted to a cholera treatment center in urban Haiti. Am J Trop Med Hyg 89: 625632.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Charles M, Delva GG, Boutin J, Severe K, Peck M, Mabou MM, Wright PF, Pape JW, 2014. Importance of cholera and other etiologies of acute diarrhea in post-earthquake Port-au-Prince, Haiti. Am J Trop Med Hyg 90: 511517.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Mehandru S, Poles MA, Tenner-Racz K, Horotwitz A, Hurley A, Hogan C, Boden D, Racz P, Markowitz M, 2004. Primary HIV-1 infection is associated with preferential depletion of CD4+ T lymphocytes from effector sites in the gastrointestinal tract. J Exp Med 200: 761770.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 338 254 19
Full Text Views 284 7 0
PDF Downloads 79 11 0
 

 

 

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