Prevalence of enteric pathogens in HIV-related diarrhea in the midwest

HIV disease is often associated with the condition of diarrhea, which may b e accompanied by enteric infection or gastrointestinal tumor. This study pr ospectively investigated 27 episodes of chronic diarrhea in 24 patients wit h HIV infection. Upper endoscopy and sigmoidoscopy with biopsies at three s ites (distal duodenum, sigmoid colon, and rectum) and viral and mycobacteri al blood cultures were performed. Stool specimens were sent for standard te sts. A primary infectious diagnosis was found in 10 (37%) of 27 episodes: c ytomegalovirus (CMV) colitis (n = 4), 3 microsporidiosis (n = 3), cryptospo ridiosis (n = 2), and colonic histoplasmosis (n = 1). Patients with CD4 cou nts of less than 50 cells/mm(3) and with lower albumin levels were more lik ely to have a primary infectious diagnosis. Adenovirus was found in 7 cases but was often associated with another organism; these were not considered to be primary diagnoses. Blood cultures for viruses were not useful, and al l mycobacterial cultures were negative. A flexible sigmoidoscopy with histo logic examination and culture of biopsy samples were the diagnostic tools t hat yielded most infectious diagnoses. Follow-up showed that two thirds of patients improved with nonspecific antidiarrheal medications regardless of diagnosis. The study supports a minimalistic approach to the problem of dia rrhea in patients with HIV infection. Upper and lower endoscopy lead to a p recise diagnosis in a minority of cases, and the outcome was similar in pat ients with or without a primary infectious diagnosis.