Molecular markers of acute intestinal infections in HIV-infected patients in the Chechen Republic

Abstract

Introduction. Diarrheal syndrome is the most characteristic symptom of HIV infection, which occurs in 70% of patients and is often fatal. The severity of diarrheal syndrome, irrespective of immune status, is usually determined by specific microorganisms colonising the gastrointestinal tract.
 The objective of this study is to assess the prevalence of classical pathogens of acute intestinal infections in diarrheal syndrome in HIV-infected residents of the Chechen Republic (Grozny).
 Materials and methods. Stool samples (n = 191) of HIV-infected patients with a history of diarrheal syndrome were studied by real-time PCR with two kits of reagents: "AmpliSens OKI screen-FL" for the detection of DNA/RNA of Shigella spp./EIEC, Salmonella spp., Campylobacter spp., Adenovirus, Rotavirus, Norovirus and Astrovirus; "AmpliSens Escherichiosis-FL" for the detection of diarrheagenic E. coli (DEC) DNA of five pathogroups: EPEC, EHEC, ETEC, EIEC, EAgEC.
 Results. Genetic markers of the acute intestinal infection pathogens were detected in 20.9% of the examined individuals. In patients aged 0–7 years and 18–24 years, DNA/RNA of the tested pathogens were not detected. DNA of bacterial pathogens accounted for 93.9%, RNA of viral pathogens — 6.1%. The etiological structure of bacterial infections was represented by a significant predominance of DEC (84.8%) compared to 10.9% of Campylobacter spp. and 4.4% of Salmonella spp. The structure of viral infections included 66.7% Rotavirus and 33.3% Norovirus. Genetic markers of Adenovirus and Astrovirus have not been identified. In 77.5% of HIV-infected patients, diarrheal syndrome was caused by one pathogen (mono-infection), but in nine examined patients (22.5%) it had a combined etiology.
 Conclusion. The etiology of acute intestinal infections in HIV-infected patients of the Chechen Republic includes bacterial and viral pathogens, in every fifth the cause of diarrheal disease was DEC. Due to diarrhea in HIV-infected people being a polyetiological disease, it is necessary to introduce a comprehensive, fast, reliable, and affordable method for identifying a wide range of pathogens that cause secondary infections.