Infectious diarrhoea in antiretroviral therapy-naïve HIV/AIDS patients in Kenya

Background: Diarrhoea is a significant cause of morbidity and mortality in immunocompromised patients. The objectives of this study were to investigate the aetiological agents, risk factors and clinical features associated with diarrhoea in HIV/AIDS patients in Kenya. Methods: Sociodemographic, epidemiological and clinical datawere obtained for 164 HIV/AIDS patients (70 with and 94 without diarrhoea) recruited from Kenyatta National Hospital, Kenya. Stool samples were examined for enteric pathogens by microscopy and bacteriology. Results: Intestinal protozoa and fungi were identified in 70% of patients, more frequently in those with diarrhoea (P<0.001). Helminths were detected in 25.6% of patients overall, and bacterial pathogens were identified in 51% of patients with diarrhoea. Polyparasitism was more common in patients with diarrhoea than those without (P<,0.0001). Higher CD4⁺ T-cell count (OR 1/4 0.995, 95% CI 0.992-0.998) and water treatment (OR 1/4 0.231, 95% CI 0.126-0.830) were associated with a lower risk of diarrhoea, while close contact with cows (OR 1/4 3.200, 95% CI 1.26-8.13) or pigs (OR 1/4 11.176, 95% CI 3.76-43.56) were associated with a higher risk of diarrhoea. Conclusions: Multiple enteric pathogens that are causative agents of diarrhoea were isolated from stools of antiretroviral therapy-naïve HIV/AIDS patients, indicating a need for surveillance, treatment and promotion of hygienic practices.