Unexplained diarrhoea in HIV-1 infected individuals.

BACKGROUND: Gastrointestinal symptoms, in particular diarrhoea, are common in non-treated HIV-1 infected individuals. Although various enteric pathogens have been implicated, the aetiology of diarrhoea remains unexplained in a large proportion of HIV-1 infected patients. Our aim is to identify the cause of diarrhoea for patients that remain negative in routine diagnostics. METHODS: In this study stool samples of 196 HIV-1 infected persons, including 29 persons with diarrhoea, were examined for enteropathogens and HIV-1. A search for unknown and unexpected viruses was performed using virus discovery cDNA-AFLP combined with Roche-454 sequencing (VIDISCA-454). RESULTS: HIV-1 RNA was detected in stool of 19 patients with diarrhoea (66%) compared to 75 patients (45%) without diarrhoea. In 19 of the 29 diarrhoea cases a known enteropathogen could be identified (66%). Next to these known causative agents, a range of recently identified viruses was identified via VIDISCA-454: cosavirus, Aichi virus, human gyrovirus, and non-A non-B hepatitis virus. Moreover, a novel virus was detected which was named immunodeficiency-associated stool virus (IASvirus). However, PCR based screening for these viruses showed that none of these novel viruses was associated with diarrhoea. Notably, among the 34% enteropathogen-negative cases, HIV-1 RNA shedding in stool was more frequently observed (80%) compared to enteropathogen-positive cases (47%), indicating that HIV-1 itself is the most likely candidate to be involved in diarrhoea. CONCLUSION: Unexplained diarrhoea in HIV-1 infected patients is probably not caused by recently described or previously unknown pathogens, but it is more likely that HIV-1 itself plays a role in intestinal mucosal abnormalities which leads to diarrhoea.

[Compulsive exercise in anorexia nervosa]. / Dwangmatig bewegen bij anorexia nervosa.

Anorexia nervosa is the most deadly mental disorder. Early detection is crucial. Most patients engage in compulsive exercise, often in an early stage. Compulsive exercise has a deleterious impact on the course of the disease. It can manifest in extreme forms with rigid rules and an inevitable urge. Three different subtypes exist: intensive sports, increased movement in everyday life, and motor restlessness. Besides the underlining motives, neurobiological mechanisms play a role. Moreover, cold ambient temperature increases compulsive exercise, while many patients intentionally expose themselves to cold. Compulsive exercise disappears only partly after weight recovery. Therefore, it needs specific treatment. Psycho-education is indispensable: to learn the difference between healthy and compulsive exercise. Besides decreasing excessive exercising, supervised exercise training is helpful. In short, think of AN in case of compulsive exercise and think of compulsive exercise of case of AN. Pose the right questions to get an impression of the severity.