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Previous Volume 329:1696-1702 December 2, 1993 Number 23 Next

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ABSTRACT

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 of 429 infants born to HIV-positive or HIV-negative mothers in Zaire to determine the incidence of acute, recurrent ( 2 episodes), and persistent ( 14 days) diarrhea; outcome; and risk factors.

Results Of the 238 infants whose mothers were HIV-positive, 53 were infected, 139 were uninfected, and the HIV status of 46 could not be determined. As compared with uninfected infants, infected infants had higher incidence rates for acute diarrhea (170 vs. 100 episodes per 100 child-years, P = 0.003), recurrent diarrhea (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 independently associated with symptomatic HIV type 1 infection in the mother (relative hazard, 1.5; P = 0.08). The incidence of persistent diarrhea in the uninfected infants of seropositive mothers was nearly double that in the uninfected infants of seronegative mothers (4.9 vs. 2.7 episodes per 100 child-years), and the risk increased if the mother died (relative hazard, 10.4). Significant growth impairment and severe immunosuppression occurred in the six to eight weeks before the onset of persistent diarrhea.

Conclusions In Zaire, infants with HIV infection have an 11-fold increased risk of death from diarrhea, largely persistent diarrhea, which is often preceded by recurrent episodes of acute diarrhea, malnutrition, or immunosuppression. Illness and death of the mother increase that risk, even among her uninfected infants.

Source Information

From the Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Boston (D.M.T., W.M.R., G.T.K.); the Centers for Disease Control and Prevention, Atlanta (M.E.S.); the International Cooperation in AIDS Research Unit, Projet SIDA, Kinshasa, Zaire (D.M.T., U.A., K.K., B.K., M.M., T.T., C.K.); the Department of Pediatrics, Mama Yemo Hospital, Kinshasa, Zaire (F.D.); and the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (C.B.).

Address reprint requests to Dr. Keusch at the Division of Geographic Medicine and Infectious Diseases, New England Medical Center, Box 041, 750 Washington St., Boston, MA 02111.

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