Is HIV infection associated with an increased risk for cholera? Findings from a case–control study in Mozambique

SummaryObjective  As residents of sub‐Saharan Africa are at high risk for HIV and cholera, it is biologically plausible that immune suppression caused by HIV infection predisposes to cholera. Our aim was to assess the potential association between both diseases.Methods  We conducted a case–control study in Beira, Mozambique, a high‐risk area for HIV and cholera. Between 1 January 2005 and 30 June 2006, experienced counsellors invited 132 suspected cholera cases and 528 age‐ and sex‐matched controls to an HIV counselling and testing centre.Results  Forty (30%) of the invited cases and 127 (24%) of the invited controls came for HIV testing. No significant differences in demographic and socio‐economic baseline characteristics were detected between participants and non‐participants. Twentyfive of 167 (15%) individuals who underwent testing were found HIV‐positive. The probability of a positive HIV‐test was highest in participants between 40 and 49 years; 6 of 14 (43%) tested HIV‐positive. Nine of 40 (23%) cholera cases were found to be HIV‐infected compared with 16 of 127 (13%) controls (adjusted odds ratio 2.6; 95% CI 0.9–7.5; P = 0.08).Discussion  The findings suggest that in a cholera‐endemic area, HIV infection is associated with an increased risk for cholera. More research in HIV endemic settings is needed to confirm the findings and to explore the effect of HIV‐related immunosuppression on the transmission of cholera.