A PROSPECTIVE-STUDY OF DIARRHEA AND HIV-1 INFECTION AMONG 429 ZAIRIANINFANTS

Background. Persistent diarrhea is a prominent feature of the acquired immunodeficiency syndrome in adults, but its cause and its effect on children with human immunodeficiency virus (HIV) infection are largely unknown, particularly in Africa. Methods. We studied a birth cohort o f 429 infants born to HIV-positive or HIV-negative mothers in Zaire to determine the incidence of acute, recurrent (greater-than-or-equal-to 2 episodes), and persistent (greater-than-or-equal-to 14 days) diarrh ea; outcome; and risk factors. Results. Of the 238 infants whose mothe rs were HIV-positive, 53 were infected, 139 were uninfected, and the H IV status of 46 could not be determined. As compared with uninfected i nfants, infected infants had higher incidence rates for acute diarrhea (170 vs. 100 episodes per 100 child-years, P = 0.003), recurrent diar rhea (21 vs. 11, P = 0.12), and persistent diarrhea (19 vs. 4, P<0.003 ). Persistent diarrhea developed in 11 HIV-infected infants; all but 1 died. It also developed in 19 uninfected infants; all but 1 survived. The prevalence of stool pathogens was similar in the two groups. In a multivariate model, persistent diarrhea in an infant was independentl y associated with symptomatic HIV type 1 infection in the mother (rela tive hazard, 1.5; P = 0.08). The incidence of persistent diarrhea in t he uninfected infants of seropositive mothers was nearly double that i n the uninfected infants of seronegative mothers (4.9 vs. 2.7 episodes per 100 child-years), and the risk increased if the mother died (rela tive hazard, 10.4). Significant growth impairment and severe immunosup pression occurred in the six to eight weeks before the onset of persis tent diarrhea. Conclusions. In Zaire, infants with HIV infection have an 11-fold increased risk of death from diarrhea, largely persistent d iarrhea, which is often preceded by recurrent episodes of acute diarrh ea, malnutrition, or immunosuppression. illness and death of the mothe r increase that risk, even among her uninfected infants.