Verma Abhishek, Hine Ashley M, Joelson Andrew, Mei Rena, Pitts Robert A, Lebwohl Benjamin, Axelrad Jordan E
Department of Medicine, NYU Grossman School of Medicine, New York, NY USA.
University of Connecticut School of Medicine, University of Connecticut, Farmington, CT, USA.
Therap Adv Gastroenterol. 2022 Apr 28;15:17562848221092593. doi: 10.1177/17562848221092593. eCollection 2022.
Diarrhea is common in persons living with HIV (PLWH)/AIDS. With the increasing utilization of multiplex gastrointestinal PCR panel (GI panel) testing, we aimed to characterize the roles of CD4 count and hospitalization in GI panel assessments of PLWH with acute diarrhea.
We performed a cross-sectional study of adult PLWH with acute diarrhea who underwent GI panel testing at two urban academic centers. Demographic, HIV disease, GI panel result, and hospitalization data were collected, and patients were cohorted by CD4 count (CD4 < 200, CD4 200-499, CD4 > = 500). The primary outcome was enteric infection as detected by GI panel, and hospitalization.
Of 298 PLWH, 119 (39.9%) had a CD4 count below 200, 195 (65.4%) were hospitalized, and 137 (46.0%) had enteric infection. Bacterial infection correlated with higher CD4 count (41.9% (CD4 > = 500) vs 31.2% (CD4 200-499) vs 25.2% (CD4 < 200), = 0.041). Hospitalization correlated with poorly controlled HIV and fewer enteric infections (34.4% vs 68.0%, < 0.001). After adjusting for HIV disease severity, a negative GI panel remained independently associated with hospitalization (adjusted odds ratio (aOR) 5.32, 95% confidence interval (CI) 2.72-10.9), even in patients tested within 72 hours of hospitalization. Despite better HIV control, men who have sex with men (MSM) had more frequent infectious diarrhea, including from , giardiasis, and multiple pathogens. MSM status independently predicted enteric infection (aOR 1.93, 95% CI: 1.02-3.67).
GI panel results vary by HIV disease severity and hospitalization in PLWH. Clinicians - especially in the inpatient setting - should carefully consider these factors when interpreting GI panel results. Further characterization of diarrheal etiology in PLWH with a negative GI panel is needed.
Diarrhea is common in people living with HIV (PLWH) and has a variety of causes, including infections, medications, and HIV itself. Multiplex polymerase chain reaction (PCR) stool testing simultaneously evaluates for a variety of common viral, bacterial, and parasitic infections of the gastrointestinal tract, and is increasingly being used in patients with diarrhea. However, patients with HIV and diarrheal illness may have uncommon infections not typically present in those with normal immune function - and thus not routinely evaluated for in stool testing. It is not known what factors, if any, might affect the results of PCR testing in HIV-related diarrhea.In this study, we examined all PLWH who underwent stool PCR testing for diarrhea over a 4-year period. We separated the patients into groups based on HIV disease severity as measured by CD4 T-cell count, or the count of the immune cells affected by HIV. We examined whether there were differences among groups in infection rates as detected by PCR stool testing. Separately, we studied the role of hospitalization in stool PCR test results.Of 298 PLWH who underwent stool PCR testing for diarrhea, 119 had a CD4 count less than 200 (low CD4 count), 195 were hospitalized at time of testing, and 137 had a positive stool PCR test. Compared to those with a low CD4 count, subjects with less severe HIV disease were more likely to have a bacterial infection on stool PCR testing and less likely to be hospitalized. Hospitalized patients were more likely to have a negative PCR stool test, regardless of CD4 count. Many patients with a low CD4 count had diarrheal etiologies not evaluated by multiplex stool PCR. In PLWH who experience diarrhea, stool PCR testing results vary by CD4 count and hospitalization. Providers should be mindful of these factors when interpreting stool PCR test results.
腹泻在艾滋病毒感染者（PLWH）/艾滋病患者中很常见。随着多重胃肠道聚合酶链反应（PCR）检测板（GI检测板）检测的使用增加，我们旨在描述CD4细胞计数和住院治疗在急性腹泻的PLWH的GI检测板评估中的作用。
我们对在两个城市学术中心接受GI检测板检测的急性腹泻成年PLWH进行了一项横断面研究。收集了人口统计学、艾滋病毒疾病、GI检测板结果和住院数据，并根据CD4细胞计数（CD4＜200、CD4 200 - 499、CD4≥500）对患者进行分组。主要结局是GI检测板检测到的肠道感染和住院治疗。
在298例PLWH中，119例（39.9%）的CD4细胞计数低于200，195例（65.4%）住院，137例（46.0%）有肠道感染。细菌感染与较高的CD4细胞计数相关（41.9%（CD4≥500）对31.2%（CD4 200 - 499）对25.2%（CD4＜200），P = 0.041）。住院治疗与艾滋病毒控制不佳和较少的肠道感染相关（34.4%对68.0%，P＜0.001）。在调整了艾滋病毒疾病严重程度后，即使在住院72小时内进行检测的患者中，阴性的GI检测板结果仍与住院治疗独立相关（调整后的优势比（aOR）为5.32，95%置信区间（CI）为2.72 - 10.9）。尽管艾滋病毒得到了更好的控制，但男男性行为者（MSM）的感染性腹泻更频繁，包括贾第虫病和多种病原体引起的腹泻。MSM状态独立预测肠道感染（aOR为1.93，95%CI：1.02 - 3.67）。
PLWH的GI检测板结果因艾滋病毒疾病严重程度和住院情况而异。临床医生——尤其是在住院环境中——在解释GI检测板结果时应仔细考虑这些因素。需要进一步明确GI检测板结果为阴性的PLWH腹泻病因的特征。
腹泻在艾滋病毒感染者（PLWH）中很常见，有多种原因，包括感染、药物和艾滋病毒本身。多重聚合酶链反应（PCR）粪便检测同时评估胃肠道的多种常见病毒、细菌和寄生虫感染，并且越来越多地用于腹泻患者。然而，艾滋病毒和腹泻疾病患者可能有免疫功能正常者通常不存在的不常见感染——因此在粪便检测中通常不进行常规评估。尚不清楚哪些因素（如果有的话）可能影响艾滋病毒相关腹泻的PCR检测结果。在本研究中，我们检查了在4年期间接受腹泻粪便PCR检测的所有PLWH。我们根据通过CD4 T细胞计数（即受艾滋病毒影响的免疫细胞计数）测量的艾滋病毒疾病严重程度将患者分组。我们检查了PCR粪便检测在各组中检测到的感染率是否存在差异。另外，我们研究了住院治疗在粪便PCR检测结果中的作用。在298例接受腹泻粪便PCR检测的PLWH中，119例的CD4细胞计数低于200（低CD4细胞计数），195例在检测时住院，137例的粪便PCR检测呈阳性。与CD4细胞计数低的患者相比，艾滋病毒疾病不太严重的受试者在粪便PCR检测中更有可能发生细菌感染，且住院的可能性更小。住院患者无论CD4细胞计数如何，粪便PCR检测呈阴性的可能性更大。许多CD4细胞计数低的患者有多重粪便PCR未评估的腹泻病因。在经历腹泻的PLWH中，粪便PCR检测结果因CD4细胞计数和住院情况而异。提供者在解释粪便PCR检测结果时应注意这些因素。
