The seroprevalence of HIV-1 in sub-Saharan African patients with diarrhea in the community remains largely unknown. We present the findings of a 2-month study that we undertook to ascertain the seroprevalence of HIV-1 in Zambian patients presenting with acute diarrhea in a community-based health center. A total of 256 patients with diarrhea and 140 apparently healthy controls was seen. Of the patients with diarrhea, 161 were < 16 years old and 95 were adults. Most children with diarrhea were < 6 years old (147 of 161; 91%). Overall, 81 of 256 (32%) patients with diarrhea were HIV-1-seropositive. When results from children < 18 months old and possibly having maternal anti-HIV-1 antibodies were excluded, 64 of 172 (37%) patients with diarrhea were HIV-seropositive. Rates of HIV-1 seropositivity for patients with diarrhea were significantly higher than were rates for diarrhea-free controls (p < .001 for both the total population; odds ratio [OR], 95% confidence interval [CI], 1.42 < 2.48 < 4.35) and population > 18 months old (OR, 95% CI, 1.54 < 2.90 < 5.49). Among children between 18 months and 5 years old, 14 of 63 (22%) were HIV-1-seropositive compared with 8 of 62 (13%) without diarrhea (p > .05, not significant). Moreover, 49 of 95 (52%) adults with acute diarrhea were HIV-1-seropositive compared with 10 of 44 (23%) healthy adult controls (p < .003; OR, 95% CI, 1.51 < 3.62 < 8.87). No significant differences were found in HIV-1 seroprevalence rates between males and females in all age groups. These data show a close association between acute diarrhea and HIV seropositivity in Zambian adults in the community.
PIP: Chronic diarrhea is a common clinical presentation of HIV infection worldwide and a major cause of mortality in cohorts of HIV-infected African children. Findings are presented from a study of HIV-1 seroprevalence among Zambian patients presenting to George Health Center, a community-based health center northwest of center Lusaka, with acute diarrhea during March-April 1994. 256 patients with diarrhea and 140 apparently healthy controls participated in the study. Of the patients with diarrhea, 161 were under 16 years old and 95 were adults. 147 (91%) of the children with diarrhea were under age 6 years. Overall, 81 of the 256 (32%) patients with diarrhea were HIV-1-seropositive. Excluding results from infants under age 18 months who may have had maternal anti-HIV-1 antibodies, 64 of 172 (37%) patients with diarrhea were HIV-seropositive. Among children aged 18 months to 5 years, 14 of 63 (22%) were HIV-1-seropositive compared with 8 of 62 (13%) without diarrhea. 49 of 95 adults with acute diarrhea were HIV-1-seropositive compared with 10 of 44 healthy adult controls. No significant differences were found in HIV-1 seroprevalence rates between males and females in all age groups. These data point to a close association between acute diarrhea and HIV seropositivity in this research setting.