Bacterial diarrhea in persons with HIV infection, United States, 1992-2002

To describe trends in bacterial diarrhea among human immunodeficiency virus (HIV)-infected persons during 1992-2002, we examined data from a longitudinal record review study of persons with HIV infection who were receiving medical care in >100 medical facilities in 9 major United States cities.

An analysis was performed using data from 44,778 persons who were followed up for a mean of 2.6 years. We calculated incidence rates and rate ratios for bacterial diarrhea, by stage of HIV disease, and determined odds ratios (ORs) to compare bacterial diarrhea diagnosis in 2002 versus 1992.

The mean annual incidence of bacterial diarrhea was 7.2 cases per 1000 person-years. The incidence of Clostridium difficile-associated diarrhea, the most common bacterial cause of diarrhea, was 4.1 cases per 1000 person-years. Compared with persons without AIDS, persons with AIDS were more likely to have bacterial diarrhea (incidence rate ratio, 1.3-9.9, varying by clinical versus immunologic AIDS and type of bacterial diarrhea). Between 1992 and 2002, the overall rate of bacterial diarrhea in persons with clinical AIDS decreased (OR, 0.4; 95% confidence interval, 0.2-0.6). During the same period, bacterial diarrhea rates among other persons in the analysis did not significantly change.

C. difficile is the most common recognized cause of bacterial diarrhea among persons infected with HIV. The risk for bacterial diarrhea increases with increased severity of HIV disease. Health care professionals should be aware that patients with AIDS are at increased risk for bacterial diarrhea, and they should reinforce recommendations for decreasing the chances of acquiring bacterial diarrhea.