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Background  Infectious diarrhea is a common problem in the developing world, especially among people living with HIV/AIDS. Traditional diagnostic methods such as stool culture and microscopic examination are limited by resources and poor sensitivity. The use of molecular diagnostics for enteropathogen detection in this region of sub-Saharan Africa has not been fully explored. We sought to identify risk factors and characterize enteropathogens from diarrheic stools of HIV-positive patients in Gondar, Ethiopia using multiplex molecular panels targeting key infectious agents.    Methods  A cross-sectional study of 100 stool samples was performed. Samples were collected consecutively from HIV- positive patients presenting with diarrhea at University of Gondar Hospital clinic, a major center in NW Ethiopia. Genomic DNA was extracted from stool and processed using a multiplex molecular panel Allplex™ [Seegene, Canada]. Correlations between patient characteristics, symptoms, public health risk factors, and enteropathogen type (s) were studied. Eighty-six samples were successfully analyzed by molecular methods.    Results  The mean age was 35 with 43% male. Eighty percent lived in an urban area, 18% had access to well water only, and 81% practiced proper hand hygiene. The majority of patients (72%) were receiving HAART with a median CD4 cell count of 362/μL. Multiple pathogens were detected in 94% of specimens, with an average of 5 enteropathogens per sample. Common bacteria, viruses, and parasites detected were  Shigella spp./ enteroinvasive  E. coli  (80%), enterotoxigenic  E. coli  (73%),  Norovirus  (16%) and  B. hominis  (62%). CD4 cell count &lt; 500/ μL was associated with the presence of viruses ( p  = 0.004) and the absence of STEC ( p  = 0.010). The use of HAART or CD4 levels was not associated with the number of enteropathogens detected.    Conclusions  Diarrheic stool from HIV-positive outpatients in Gondar, Ethiopia had on average 5 enteropathogens present in their stool.  Shigella spp./ enteroinvasive E. coli  and  enterotoxigenic E. coli  are the major pathogens, not dissimilar to immunocompetent individuals in low income countries.

Molecular detection of Enteropathogens from diarrheic stool of HIV positive patients in Gondar, Ethiopia