Abstract
Diarrheal diseases (DD) have distinct etiological profiles in immune-deficient and immune-competent patients. This study compares detection rates, genotype distribution and viral loads of different enteric viral agents in HIV-1 seropositive (n = 200) and HIV-1 seronegative (n = 125) children hospitalized with DD in Rio de Janeiro, Brazil. Except for group A rotavirus (RVA), which were detected through enzyme immunoassay, the other enteric viruses (norovirus [NoV], astrovirus [HAstV], adenovirus [HAdV] and bocavirus [HBoV]) were detected through PCR or RT-PCR. A quantitative PCR was performed for RVA, NoV, HAstV, HAdV and HBoV. Infections with NoV (19% vs. 9.6%; p<0.001), HBoV (14% vs. 7.2%; p = 0.042) and HAdV (30.5% vs. 14.4%; p<0.001) were significantly more frequent among HIV-1 seropositive children. RVA was significantly less frequent among HIV-1 seropositive patients (6.5% vs. 20%; p<0.001). Similarly, frequency of infection with HAstV was lower among HIV-1 seropositive children (5.5% vs. 12.8%; p = 0.018). Among HIV-1 seropositive children 33 (16.5%) had co-infections, including three enteric viruses, such as NoV, HBoV and HAdV (n = 2) and NoV, HAstV and HAdV (n = 2). The frequency of infection with more than one virus was 17 (13.6%) in the HIV-1 negative group, triple infection (NoV + HAstV + HBoV) being observed in only one patient. The median viral load of HAstV in feces was significantly higher among HIV-1 positive children compared to HIV-1 negative children. Concerning children infected with RVA, NoV, HBoV and HAdV, no statistically significant differences were observed in the medians of viral loads in feces, comparing HIV-1 seropositive and HIV-1 seronegative children. Similar detection rates were observed for RVA, HAstV and HAdV, whilst NoV and HBoV were significantly more prevalent among children with CD4+ T lymphocyte count below 200 cells/mm3. Enteric viruses should be considered an important cause of DD in HIV-1 seropositive children, along with pathogens more classically associated with intestinal infections in immunocompromised hosts.
Highlights
Diarrheal diseases (DD) represent one of the leading causes of mortality in children, accounting for almost 10% of deaths in this age group [1]
The objective of this study was to compare detection rates, genotype distribution and viral load of different enteric viral agents in human immunodeficiency virus 1 (HIV-1) seropositive and HIV-1 seronegative children hospitalized with DD in Rio de Janeiro, Brazil
The present study explores the diversity of viral agents in HIV-1 seropositive patients hospitalized with DD, comparing their etiological profile with a group of HIV-1 seronegative children
Summary
Diarrheal diseases (DD) represent one of the leading causes of mortality in children, accounting for almost 10% of deaths in this age group [1]. Viruses are among the most frequently enteric pathogens identified in children with DD worldwide [2]. Classic viral enteropathogens include group A rotaviruses (RVA), noroviruses (NoV), astrovirus (HAstV) and enteric adenovirus (HAdV-F). RVA (Reoviridae family) are the major etiological agents associated with severe DD in children younger than 5 years of age in developed and developing countries [6]. Combinations of G1, G2, G3, G4, G9, and G12 with P[4], P[6] and P[8] have been the most frequently detected in humans [7]
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