Skip to main content Accessibility help
×
Home
  • Print publication year: 2008
  • Online publication date: December 2009

16 - Diarrhea in HIV-Infected Patients

from Part I - Systems
    • By George Beatty, Associate Clinical Professor of Medicine, University of California, San Francisco School of Medicine, Positive Health Program at San Francisco General Hospital, San Francisco, CA
  • Edited by Rachel L. Chin, University of California, San Francisco
  • Publisher: Cambridge University Press
  • DOI: https://doi.org/10.1017/CBO9780511547454.017
  • pp 83-88

Summary

INTRODUCTION

A useful initial approach to evaluating diarrhea in an individual infected with human immunodeficiency virus (HIV) is to distinguish acute from chronic diarrhea, and small from large bowel involvement. In addition, particular consideration should be given to the stage of HIV disease, current medications, and sexual history, as these factors help determine likely pathogens. Finally, evaluating the degree of systemic illness is essential to assessing the need for hospital admission.

Initial Approach

Acute diarrhea is defined as the presence of three or more loose or watery stools per day for less than 2 weeks. Diarrhea is defined as persistent if it has been present between 2 and 4 weeks and is considered chronic when present for 4 weeks or more. Pathogens infecting the small bowel affect the secretory and nutritional absorption functions of the gastrointestinal (GI) tract and typically present with large volumes of watery stool, often accompanied by cramps, bloating, and abdominal gas (Table 16.1). Severe or prolonged diarrhea may result in dehydration, malnutrition, and weight loss. Large bowel involvement primarily affects water resorptive capacity and typically causes frequent, small-volume diarrhea that may be bloody or mucoid and is often accompanied by pain.

EPIDEMIOLOGY

Overall, up to 40% of patients with HIV infection report at least one episode of diarrhea in any given month, and approximately one quarter of patients experience chronic diarrhea at some point.

REFERENCES
Angulo, F J, Swerdlow, D L. Bacterial enteric infections in persons infected with human immunodeficiency virus. Clin Infect Dis 1995 Aug;21(Suppl 1):S84–93.
Asmuth, D M, DeGirolami, P C, Federman, M, et al. Clinical features of microsporidiosis in patients with AIDS. Clin Infect Dis 1994 May;18(5):819–25.
Blanshard, C, Francis, N, Gazzard, B G. Investigation of chronic diarrhoea in acquired immunodeficiency syndrome. A prospective study of 155 patients. Gut 1996 Dec;39(96):824–32.
Call, S A, Heudebert, G, Saag, M, Wilcox, C M. The changing etiology of chronic diarrhea in HIV-infected patients with CD4 cell counts less than 200 cells/mm3. Am J Gastroenterol 2000 Nov;95(11):3142–6.
Chen, X M, Keithly, J S, Paya, C V, LaRusso, N F. Cryptosporidiosis. N Engl J Med 2002 May 30;346(22):1723–31.
Mayer, H B, Wanke, C A. Diagnostic strategies in HIV-infected patients with diarrhea. AIDS 1994 Dec;8(12):1639–48.
Sharpstone, D, Gazzard, B. Gastrointestinal manifestations of HIV infection. Lancet 1996 Aug 10;348(9024):379–83.
Sherman, D S, Fish, D N. Management of protease inhibitor-associated diarrhea. Clin Infect Dis 2000 Jun;30(6):908–14.
ADDITIONAL READINGS
Cohen, J, West, A B, Bini, E J. Infectious diarrhea in human immunodeficiency virus. Gastroenterol Clin North Am 2001 Sep;30(3):637–64.
Kearney, D J, Steuerwald, M, Koch, J, Cello, J P. A prospective study of endoscopy in HIV-associated diarrhea. Am J Gastroenterol 1999 Mar;94(3):596–602.
Morpeth, S C, Thielman, N M. Diarrhea in patients with AIDS. Curr Treat Options Gastroenterol 2006 Feb;9(1):23–37.
Sanchez, T H, Brooks, J T, Sullivan, P S, et al. Bacterial diarrhea in persons with HIV infection, United States, 1992–2002. Clin Infect Dis 2005 Dec 1;41(11):1621–7.
Weber, R, Ledergerber, B, Zbinden, R, et al. Enteric infections and diarrhea in human immunodeficiency virus-infected persons: prospective community-based cohort study. Swiss HIV Cohort Study. Arch Intern Med 1999 Jul 12;159(13):1473–80.