Low CD4-Cell Count Is a Risk Factor for C. difficile Infection

Abigail Zuger, MD

In one clinic's experience, HIV-related immunosuppression joined the usual risk factors.

Although Clostridium difficile infection (CDI) has become commonplace in hospitals and clinics in the last 10 years, no recent studies have examined incidence in the specific context of HIV infection. Johns Hopkins researchers retrospectively analyzed predisposing factors for CDI among 154 cases of infection diagnosed in their outpatient HIV clinic between July 2003 and December 2010.

Compared with a set of matched controls (602 HIV-infected patients without known CDI), CDI patients had lower CD4-cell counts, had higher viral loads, and were less likely to be receiving antiretroviral therapy (ART) at the time of diagnosis. They were also more likely to have recently received antibiotics of all common classes, gastric-acid suppressors, and steroids or other immunosuppressants, and to have advanced kidney disease. In multivariate analysis, CD4 count ≤50 cells/mm3 endured as a strong independent risk factor for CDI.

Treatment details were not included in this report, but patients did relatively well: Only 35 (24%) were hospitalized and none died, although 2 required a colectomy and 2 others developed toxic megacolon, which resolved without surgical intervention. The recurrence rate was <20%. The yearly incidence of CDI remained stable over the course of the study, even though ART uptake increased in the clinic population from 70% in 2003 to 84% in 2009.

CITATION(S):

Haines CF et al. Clostridium difficile in a HIV-infected cohort: Incidence, risk factors, and clinical outcomes. AIDS 2013 Nov 13; 27:2799.