From the Guidelines
Diarrhea in HIV-infected individuals is often caused by a combination of factors, including opportunistic infections, medication side effects, and HIV enteropathy, with the most recent evidence suggesting that viral agents such as rotavirus and adenovirus may also play a significant role 1. The causes of diarrhea in HIV infection can be multifaceted, involving:
- Opportunistic infections such as Cryptosporidium, Isospora, and cytomegalovirus
- Medication side effects, particularly from antiretroviral therapy
- HIV enteropathy, which involves damage to the intestinal cells by the virus
- Viral agents of gastroenteritis, including rotavirus and adenovirus, as identified in a study using electron microscopy 1 For immediate management, oral rehydration with electrolyte solutions is essential to prevent dehydration, and over-the-counter medications like loperamide (Imodium) can help control symptoms. Key considerations for managing diarrhea in HIV patients include:
- Medical evaluation to identify the cause of persistent diarrhea
- Specific antimicrobial therapy for opportunistic infections
- Antiretroviral therapy (ART) optimization to improve HIV-related diarrhea
- Dietary modifications to manage symptoms, such as avoiding spicy foods and focusing on bland foods and soluble fiber
- The potential benefits of probiotics in managing symptoms It is crucial to address diarrhea promptly in HIV patients, as persistent or severe diarrhea can lead to malnutrition, weight loss, and worsening immune function. The underlying mechanism often involves damage to intestinal cells by the virus or opportunistic pathogens, disrupting normal absorption and secretion in the gut.
From the Research
Causes of Diarrhea in HIV Infection
- Opportunistic infectious agents, including protozoa, fungi, viruses, and bacteria, can cause diarrhea in patients with HIV 2, 3
- Noninfectious diarrhea is also a common cause, with etiology being multifactorial, including:
- The prevalence of diarrhea increases with decreasing CD4 counts 5
Prevalence of Diarrhea in HIV Infection
- Up to 40% of patients with HIV infection report at least 1 episode of diarrhea in a given month 5
- Approximately 1 quarter of patients experience chronic diarrhea at some point 5
- Over half of patients with HIV experience diarrhea that contributes negatively to quality of life and adherence to antiretroviral therapy (ART) 2
Diagnosis and Management of Diarrhea in HIV Infection
- A basic algorithm for the diagnosis of diarrhea in patients with HIV includes physical examination, review of medical history, assessment of HIV viral load and CD4+ T cell count, stool microbiologic assessment, and endoscopic evaluation, if needed 2
- Pharmacologic options for the treatment of noninfectious diarrhea are primarily supportive, with crofelemer being the only therapy approved in the USA for the symptomatic relief of noninfectious diarrhea in patients with HIV on ART 2, 4
- Other treatment options, such as loperamide, may also be considered 4
- Octreotide has been shown to be effective in reducing stool frequency and volume in patients with refractory AIDS-associated diarrhea 6