Gastroenteritis in people living with HIV in Chad: Vulnerability factors and antibiotic resistance

People living with HIV (PLHIV) are vulnerable and often victims of opportunistic infections. Therefore, we undertook a study of gastroenteritis cases among them in four cities (N'Djamena, Kélo, Moundou, Sarh) in Chad. This study involved 648 patients, of whom 63% were former PLHIV on antiretroviral (ARV) therapy for more than 10 years and 37% were newly diagnosed with HIV in an advanced stage of the disease. The main objective of this study was to determine the frequencies of microorganisms associated with gastroenteritis in PLHIV, and secondarily to verify the effectiveness of the most prescribed antibiotics and to identify the adverse effects of the drugs for their management. The isolation and identification of enteropathogenesis in stools were carried out at the laboratory of the National Reference University Hospital Center (CHU-RN), using Hektoen, Mueller-Hinton, EMB, Sabouraud Chloramphenicol media and the API® 20 E gallery. Microscopy, filamentation tests and biochemical tests were used to characterize and determine the rates of parasitic, fungal and bacterial infections, which were 9.6%, 11.3% and 3% respectively. Between long-term (67%) and new (37%) PLHIV, significant differences were observed regarding the adverse effects of antiretroviral therapy (ARV) (vomiting/nausea (p = 0.02), skin rashes (p = 0.001)). Characterization of the susceptibility of the bacterial agents Salmonella, Shigella, and enterohemorrhagic Escherichia coli showed an average resistance rate (76%) to sulfamethoxazole-trimethoprim and nalidixic acid, and 50% resistance to aminopenicillins. On the other hand, an average sensitivity rate of 90% was observed with respect to fluoroquinolones, tetracycline and imipenem. This study not only revealed the characteristics of diarrhea, but also highlighted an effective antibiotic therapy for the prevention of diarrheal diseases in PLHIV in Chad.