Managing diarrhea in HIV/AIDS may be more complicated than in immunocompetent (not immunocompromised) patients as it may be caused by many rare opportunistic infections that would not otherwise be immediately considered. Chronic diarrhea may begin in the mildly symptomatic stage of the infection and persist through to the onset of AIDS. The complications associated with chronic diarrhea is one of the more common causes of mortality in HIV/AIDS.
What is HIV Diarrhea?
Diarrhea is defined as the passage of more than 200g (grams) of stool per day in adults. However, in the case of watery stools a volume greater than 200ml (milliliters) is considered as diarrhea. For infants, more than 10g (grams) per kg (kilogram) of body weight will be considered as diarrhea.
Diarrhea stool may be firm, soft or loose and/or watery. This consistency is not a sole indication of diarrhea. Frequent large volume/weight (>200g/200ml) bowel movements is considered as diarrhea. More than 3 bowel movements per day may also be considered as diarrhea unless the total daily volume is within the norm. Persistent diarrhea usually lasts for more than 14 days and any case of diarrhea that is ongoing for more than 30 days will be considered as chronic diarrhea.
Acute bouts of diarrhea, whether a person is HIV-positive or not, is a common occurrence. This should be differentiated from HIV/AIDS-related chronic diarrhea, which often presents with other gastrointestinal symptoms like difficulty on swallowing (dysphagia) or painful swallowing (odynopahgia).
Symptoms of Diarrhea in HIV/AIDS
Identifying the type of diarrhea stool may assist your doctor with isolating a possible cause. Ideally a stool test should be conducted and a culture may help identify the causative organism. Supportive treatment may not be sufficient and the appropriate drugs directed at the cause is essential. Antimotility agents should be used with caution if the cause is due to an infection. It should be used along with antimicrobial drugs and stopped once the diarrhea eases or resolves.
Watery stools are usually larger in volume than firm or soft stools due to the amount of water passed out with the stool. At times there may be no sign of solid excrement and only water is evacuated. This more likely indicates a pathology affecting the small intestine.
Bloody stools are usually smaller in volume as the amount of evacuated water is less. However, the stool consistency is often affected – loose or soft. This may indicate a pathology within the large intestine.
Chronic diarrhea may lead to dehydration, affect heart and kidney functioning and contribute to weight loss.
Causes of Chronic Diarrhea in HIV/AIDS
Chronic diarrhea in HIV infection may indicates a drop in CD4 cell count or the possibly even the onset of AIDS. Diarrhea plays a significant role in weight loss in HIV/AIDS, along with other gastrointestinal symptoms which reduces appetite, hampers ingestion and decreases nutrient absorption. Chronic diarrhea in HIV-positive patients should be investigated to identify the onset of AIDS-defining illnesses.
Some of the causes of chronic diarrhea in HIV/AIDS includes :
- Cytomegalovirus (CMV) infection – bloody stool (more common) or watery, non-bloody.
- Cryptosporidiosis – watery stool (more common) or bloody stool.
- Isosporiasis – watery stool.
- Microsporidiosis – watery stool.
- Mycobacterium avium intracellulare infection -watery stool.
- Salmonella – bloody stool, initially watery.
The presence of these infections in a case of chronic diarrhea should always warrant an HIV test if HIV infection has not as yet been excluded. HIV patients require CD4 T-cell count and viral load tests. HAART (highly active antiretroviral therapy) may have to be commenced as immune restoration is essential for a good prognosis.
Other causes of chronic diarrhea in HIV/AIDS may include :
- Clostridium difficile.
- Drug side effects may cause chronic diarrhea, especially antiretroviral (ARV) medicines like protease inhibitors.
- Escherichia coli.
- Excessive use of nutritional (vitamin, mineral) or herbal supplements.
- HIV enteropathy.
Other causes of acute diarrhea in immunocompetent persons may result in chronic diarrhea in HIV/AIDS patients.
Preventing Diarrhea in HIV
After the diarrhea resolves with proper medical treatment, the focus should be on preventing diarrhea in HIV/AIDS patients. This may not always be possible but any person living with HIV and caregivers should be aware of basic prevention measures.
- Wash hands frequently with antiseptic soaps.
- Boil water (even tap water) for patients with a low CD4 count.
- Practice good hygiene when handling and preparing food and store cooked food appropriately. Avoid eating out at restaurants or take-out foods.
- Limit contact with others who are unwell whether they have an infectious disease or not.
- Regular change of diapers (in adults or infants) is necessary. Soiled clothing should be washed and sterilized.
- Wash and sterilize bedding frequently for debilitated patients.
- Clean toilets and bathrooms with disinfectants at least twice a day.
These measures will not assist every case of chronic diarrhea in AIDS patients (due to non-infectious causes or a very low CD4 count), however, it will help with reducing complications and the chances of other infections.