Abstract
BackgroundDiarrhea is an important health problem among HIV-infected patients. This study evaluated the role of HIV in the epidemiology, etiology, and severity of diarrheal disease among children. MethodsThe Global Enteric Multicenter Study enrolled children with moderate-to-severe diarrhea (MSD) and less-severe diarrhea (LSD) between December 2007 and November 2012. One to three controls for MSD cases and one per LSD case were enrolled and matched by age, sex, and neighborhood. All children were tested for HIV. Clinical data, anthropometric data, and stool samples were collected. Follow-up was performed at 60 days. ResultsTwo hundred and fourteen MSD cases and 418 controls, together with 349 LSD cases and 214 controls were tested. HIV prevalence was 25% among MSD cases (4% for matched controls) and 6% among LSD cases (6% among matched controls). HIV-infected children were more likely to have MSD (odds ratio 5.6, p<0.0001).Mortality rates were higher among HIV-infected children than among the uninfected (34 vs. 5 per 1000 child-weeks at risk; p=0.0039). Cryptosporidium, Giardia, and enteroaggregative Escherichia coli (aatA only) were more prevalent among HIV-infected MSD cases than among uninfected ones. ConclusionHIV is an important risk factor for MSD. The high mortality rate implies that children with MSD should be screened for HIV and managed accordingly.
Highlights
HIV is a significant public health problem worldwide
HIV prevalence was higher among moderate-to-severe diarrhea (MSD) cases (23%, 49/ 214; 95% confidence intervals (95% CI) 17.72–29.06) than among MSD matched controls (4%, 17/418; 95% CI 2.54–6.46)
HIV prevalence in the less-severe diarrhea (LSD) group was similar among cases and controls: 7% (26/349; 95% CI 5.11–10.74) in LSD cases and 7% (14/ 214; 95% CI 3.90–10.78) in their matched LSD controls
Summary
HIV is a significant public health problem worldwide. Globally, it is estimated that 2.1 million children under 15 years of age are infected by HIV, with about 160 000 new infections and 120 000 related deaths annually (World Health Organization, 2017a), the majority of which occur in Sub-Saharan Africa. The HIV pandemic has hit Mozambique hard This is currently one of the most affected countries in the world, with a nationally reported HIV prevalence in adults of 13% (Instituto Nacional de Saúde (INS) and Instituto Nacional de Estatística (INE), 2017), community cross-sectional studies conducted in recent years in the district of Manhiça have repeatedly estimated the HIV prevalence in this specific district to be as high as 40% (Gonzalez et al, 2015, 2012).
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