Effect of human immunodeficiency virus infection on episodes of diarrhea among children in South Africa

Background. Infection with HIV is increasing among children in South Africa , Diarrhea is a common cause of morbidity and mortality in Africa, and some studies have shown that HIV-infected children have episodes of severe diar rhea with higher mortality than HIV-uninfected children. Objectives, To compare the severity, pathogens and outcome of diarrhea in H IV-infected and uninfected children. Methods. We studied 181 children ages 3 months to 4 years admitted for gast roenteritis to the Chris Hani Baragwanath Hospital in Soweto, South Africa. Demographic details of the children were recorded, as were the details of the episode of diarrhea. Stools specimens were collected and sent for micro biologic evaluation. The clinical course of the child's admission was recor ded. Children were diagnosed as being infected with HIV if they tested posi tive by HIV enzyme-linked immunosorbent assay (ELISA) and were >15 months o f age, or if they were ELISA-positive, were <15 months of age and had clini cal signs of HIV infection. Results. Of the 176 children with an HIV ELISA result, 31 (17.6%) were clas sified as HIV-infected. More HIV-infected children were malnourished (80.6% vs. 39.5%, P < 0.001) and more likely to have had prolonged diarrhea (16.1 % vs. 5.9%, P = 0.07) compared with HIV-uninfected children. HIV-infected c hildren had a higher rate of a codiagnosis of pneumonia (43.3% vs. 9.2%, P < 0.0001) and were more likely to require a hospital stay of >4 days (preva lence odds ratio, 5.11; 95% confidence interval, CI 1.49 to 17.52). There w ere no significant differences in stool pathogens or in the level of dehydr ation on admission between the HCV-infected and uninfected children. Conclusion. HIV-infected children have the same spectrum of enteric pathoge ns as uninfected children but require more attention because of malnutritio n and comorbidity.