What is it about?
People living with HIV are at higher risk of Clostridium (now Clostridioides) difficile infection, a cause of diarrhoea and colitis often linked to antibiotics, but the reasons are not well understood. We reviewed the records of HIV patients admitted to the National Institute for Infectious Diseases L. Spallanzani in Rome between 2002 and 2013, comparing those who developed C. difficile infection with matched patients who did not. We found 79 episodes, about 5 per 1,000 HIV admissions. Many factors were linked to infection, including antibiotics, tuberculosis drugs, Pneumocystis treatment, stomach acid suppressants, previous hospitalization and low CD4 counts. However, in the final analysis only two factors remained independently associated: low levels of gammaglobulins (antibodies) and low albumin at admission.
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Why is it important?
These findings suggest that a weakness in antibody-mediated (humoral) immunity, rather than only the loss of CD4 cells, plays a key role in C. difficile infection among people with HIV. Simple blood tests at admission could help identify high-risk patients, and the possible protective role of albumin deserves further research.
Perspectives
This study, carried out during my years at the Spallanzani Institute, was one of the first steps in my long research journey on Clostridioides difficile and host immunity. The link between antibodies and susceptibility later became a central theme of my work, including on vaccines and antibody-based prevention.
Professor Stefano Di Bella
Universita degli Studi di Trieste
Read the Original
This page is a summary of: Clostridium difficile infection among hospitalized HIV-infected individuals: epidemiology and risk factors: results from a case-control study (2002-2013), BMC Infectious Diseases, April 2015, Springer Science + Business Media,
DOI: 10.1186/s12879-015-0932-x.
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