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Open Access Highly Accessed Research article

Unexplained diarrhoea in HIV-1 infected individuals

Bas B Oude Munnink1, Marta Canuti1, Martin Deijs1, Michel de Vries2, Maarten F Jebbink1, Sjoerd Rebers3, Richard Molenkamp3, Formijn J van Hemert1, Kevin Chung1, Matthew Cotten4, Fransje Snijders5, Cees JA Sol3 and Lia van der Hoek1*

Author Affiliations

1 Laboratory of Experimental Virology, Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands

2 CBS-KNAW Fungal Biodiversity Center, Utrecht, The Netherlands

3 Laboratory of Clinical Virology, Department of Medical Microbiology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center of the University of Amsterdam, Amsterdam, The Netherlands

4 Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, UK

5 Beatrix Hospital, Gorinchem, The Netherlands

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BMC Infectious Diseases 2014, 14:22  doi:10.1186/1471-2334-14-22

Published: 13 January 2014

Abstract

Background

Gastrointestinal symptoms, in particular diarrhoea, are common in non-treated HIV-1 infected individuals. Although various enteric pathogens have been implicated, the aetiology of diarrhoea remains unexplained in a large proportion of HIV-1 infected patients. Our aim is to identify the cause of diarrhoea for patients that remain negative in routine diagnostics.

Methods

In this study stool samples of 196 HIV-1 infected persons, including 29 persons with diarrhoea, were examined for enteropathogens and HIV-1. A search for unknown and unexpected viruses was performed using virus discovery cDNA-AFLP combined with Roche-454 sequencing (VIDISCA-454).

Results

HIV-1 RNA was detected in stool of 19 patients with diarrhoea (66%) compared to 75 patients (45%) without diarrhoea. In 19 of the 29 diarrhoea cases a known enteropathogen could be identified (66%). Next to these known causative agents, a range of recently identified viruses was identified via VIDISCA-454: cosavirus, Aichi virus, human gyrovirus, and non-A non-B hepatitis virus. Moreover, a novel virus was detected which was named immunodeficiency-associated stool virus (IASvirus). However, PCR based screening for these viruses showed that none of these novel viruses was associated with diarrhoea. Notably, among the 34% enteropathogen-negative cases, HIV-1 RNA shedding in stool was more frequently observed (80%) compared to enteropathogen-positive cases (47%), indicating that HIV-1 itself is the most likely candidate to be involved in diarrhoea.

Conclusion

Unexplained diarrhoea in HIV-1 infected patients is probably not caused by recently described or previously unknown pathogens, but it is more likely that HIV-1 itself plays a role in intestinal mucosal abnormalities which leads to diarrhoea.

Keywords:
Diarrhoea; HIV-1; VIDISCA-454; Aichi virus; Human gyrovirus; Cosavirus; Immunodeficiency-associated stool virus; NonA-nonB hepatitis virus; Norovirus; Sapovirus