Objectives: To examine relationships between diarrhoea, CD4 cell counts and stool pathogens in a community-based cohort of HIV-infected adults in Uganda. Patients and methods: Stool specimens, obtained between October 1995 and December 1997, were linked to patients' symptoms and laboratory results. The relationship between CD4 counts and symptoms was tested using the Wilcoxon rank-sum test and those between organisms and diarrhoea using first a univariate Mantel-Haenszel analysis and then a logistic regression model adjusted for CD4 count and multiple organisms. Results: 1213 HIV-infected individuals (70% women, median CD4 cell count at enrollment 215 cells/µl) were followed for 1224 person years of observation (pyo). 484 stool samples were examined, 357 from patients with diarrhoea. The rate of diarrhoea was 661 episodes per 1000 pyo. CD4 counts were significantly lower in individuals with diarrhoea than those without (PCryptosporidium parvum infection alone was associated with low CD4 counts. Conclusions: Diarrhoea was common and most strongly associated with low CD4 counts. Bacteria were frequently found, even in stools from asymptomatic individuals. Over two-thirds of diarrhoeal episodes were undiagnosed, suggesting that unidentified agents or primary HIV enteropathy are important causes of diarrhoea in this population.
Journal of Infection (2002) 45 (2) pp. 99-106 [doi:10.1053/jinf.2002.1002]