How To Stop Diarrhea In Hiv Patients

When To Call Your Doctor About Your Diarrhea

A bout of diarrhea that goes away after a few days, or that doesn’t interfere with your life, isn’t necessarily something to be worried about. But if you’re even a little concerned, it doesn’t hurt to check in with your healthcare provider or clinic.

If you have any of the following symptoms, however, you should call your doctor as soon as possible, since they may be signs of a more dangerous health problem:

• Your diarrhea hasn’t gone away after more than a couple of days
• Your diarrhea has blood in it
• You develop a fever
• You’re also vomiting
• You have a lot of trouble urinating
• You can urinate, but it’s much darker than usual
• Your mental state changes
• You start getting headaches
• You’re rapidly losing weight

Primary Immune Deficiency Diseases

NIH Clinical Research Center

NIH Clinical Research Center

Primary immune deficiency diseases are rare, genetic disorders that impair the immune system. Without a functional immune response, people with PIDDs may be subject to chronic, debilitating infections, such as Epstein-Barr virus , which can increase the risk of developing cancer. Some PIDDs can be fatal. PIDDs may be diagnosed in infancy, childhood, or adulthood, depending on disease severity.

The Stages Of Hiv Infection

Currently, there is no cure for HIV infection.

HIV infection has three distinct stages, as defined by the CDC : HIV Primary or Acute infection, HIV Chronic or Asymptomatic infection, and HIV as AIDS.

Acquired Immunodeficiency Syndrome is the final stage of HIV infection. AIDS occurs when the bodys immune system has been so badly damaged that the individual is highly vulnerable to diseases, infections, and even infection-related cancers.

Common problems of individuals with HIV infection are:

• Consistently taking medication

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Why Hiv Causes Diarrhea

HIV is a serious condition that can compromise the immune system and cause further health complications, including diarrhea. HIV-associated diarrhea can develop when there is an infection in the intestines but can also develop as a result of the effects of HIV on the body and, more specifically, the gastrointestinal system.

One in five individuals with HIV has diarrhea and more than half of individuals diagnosed with HIV experience diarrhea severe enough to negatively affect their quality of life. But how exactly does HIV cause diarrhea?

Why Do HIV-Positive Patients Get Diarrhea?

HIV-associated diarrhea has three main causes:

• HIV enteropathy: Diarrhea caused by direct or indirect damage to the mucosal layer of the intestines by the HIV infection is referred to as HIV enteropathy. HIV enteropathy is chronic diarrhea in HIV-positive individuals that lasts for more than one month. It is not caused by an infectious pathogen, such as bacteria.

• Antiretroviral therapy -associated diarrhea: One of the most common side effects of some ART medications is diarrhea. Diarrhea caused by ART medications can even deter patients from taking their ART medications, leaving them vulnerable to health complications and an impaired immune system.

ART Has Decreased the Overall Incidence of Infectious Diarrhea

Why Is it Important to Treat HIV-Associated Diarrhea?

If not treated upon diagnosis, or if left untreated, diarrhea can lead to serious health complications, including:

• Dehydration

How Is Diarrhea Treated

1. CHANGE WHAT YOU EAT:

Some foods can cause diarrhea, and others can help stop it.

Dont eat:

• dairy products
• greasy or fried food

• oatmeal
• mashed potatoes
• yogurt

2. DRUG TREATMENTS:

Different medications are used to treat different types of diarrhea. Your health care provider will not be able to prescribe a medication without some idea of what is causing your diarrhea.

You do not need a prescription for over-the-counter treatments. Some of these work very well for diarrhea, including:

• The amino acid L-glutamine
• Kaopectate
• Imodium AD

Some other products that are usually sold to treat constipation can also help with diarrhea. These products contain “soluble” fiber that adds bulk and absorbs water. This includes products like Metamucil, Citrucel, or other products that contain psyllium.

3. ALTERNATIVE THERAPIES FOR DIARRHEA

Acidophilus capsules can help restore normal digestion, especially when you are taking antibiotics. Some types of yogurt contain “live cultures” of acidophilus that work the same way.

Peppermint, ginger and nutmeg are believed to help with digestive problems. Peppermint or ginger tea or ginger ale would be good choices for “clear liquids”. Try adding nutmeg to your food or drinks.

Studies have shown that calcium supplements helped relieve diarrhea in people taking nelfinavir . This might work for diarrhea caused by other medications.

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Role Of Bovine Colostrum In Treatment Of Hiv

A few observational studies have been published on the effect of bovine colostrum preparations in HIV-associated diarrhea. In one of these a substantial therapeutic effect was reported in 25 patients, 40% of whom had a complete remission and 24% a partial remission of diarrheal disease post treatment. In other studies, the efficacy of treatment with colostrum preparations was reported in Cryptosporidium– associated diarrhea in patients with AIDS.

Bovine colostrum is the first milk the lactating cow gives to the suckling calf during the first days of life. Its composition is quite different from that of ruminant milk in established lactation and is characterized by its very high level of several bioactive components: immunoglobulins, growth factors, some whey proteins and proteinase inhibitors, vitamins and minerals. The biological function of colostrum is to, through its composition, provide the calf with passive immunity, support calf growth and prevent gastrointestinal infections until the calfs own immune system is fully functional.

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 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 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 , however, it will help with reducing complications and the chances of other infections.

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How Often Do You Have Diarrhea With Hiv

She is an internist specializing in HIV and an assistant professor of infectious diseases at the University of Alabama at Birmingham. Latesha Elopre, MD, is a board-certified internist. People living with HIV are at risk for diarrhea, with as many as 60% experiencing three or more loose or watery bowel movements per day.

Botanical Drug Fulyzaq Receives Fda Approval To Treat Diarrhea In Hiv/aids Patients On Antiretroviral Therapy

The US Food and Drug Administration announced today the approval of Fulyzaq to relieve symptoms of diarrhea in HIV/AIDS patients taking antiretroviral therapy, a combination of medicines used to treat HIV infection, according to a FDA press release Dec. 31.

Derived from the red sap of the Croton lechleri plant, Fulyzaq is the second botanical prescription drug approved by FDA. A botanical drug product is often a complex mixture derived from one or more plant materials with varying degrees of purification.

Fulyzaq is distributed by Salix Pharmaceuticals, based in Raleigh, N.C. under license from Napo Pharmaceuticals, Inc.

According to the FDA, many HIV/AIDS patients who take antiretroviral therapies experience diarrhea as a side effect. This causes some patients to stop taking their medications or switching to other medications.

Taking Fulyzaq two times a day can help manage diarrhea due to reasons other than viral, bacterial or parasitic infections.

Currently, there are no FDA-approved therapies for HIV-associated diarrhea, said Julie Beitz, M.D., director of the Office of Drug Evaluation III in FDAs Center for Drug Evaluation and Research. Fulyzaq may be helpful to HIV/AIDS patients with this troublesome condition.

The FDA advises health care providers before treating diarrhea with Fulyzaq, ensure testing is performed to rule out infectious agents as the cause of the diarrhea.

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The Role Of A Structurally Intact Small Intestine

As early as 1984, Kotler and associates described an HIV-associated enteropathy with structural resemblance to celiac disease. There is thus a reduced villous height in HIV infection and also a CD4+ mucosal lymphopenia and an increase in CD8+ lymphocytes. Further, there is an enhanced intestinal permeability, possibly leading to a greater influx of lipopolysaccharides, which are bacterial antigens from gram-negative bacteria. This can clearly be a factor that causes diarrheal disease and exacerbates or causes malnutrition.

Should Arv Be Withheld At This Time

When considering temporary discontinuation of ARV regimens, clinicians must weigh the likelihood of ARV toxicity, severity of illness and potential harm if an offending agent is continued against the potential harms of treatment interruption. Factors suggesting ARV-related diarrhea include an ARV regimen known to cause diarrhea and a temporal relation between diarrhea and ARV initiation. Current guidelines recommend short-term interruption of ARV only when a patient experiences severe or life-threatening toxicity or cannot take oral medications.3 If a decision is made to interrupt treatment, the entire ARV regimen should be withheld. Long-term interruption of ARV therapy is not recommended.3 Management of ARV-associated diarrhea should be carried out in consultation with a clinician who has experience managing the treatment of patients with HIV.

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Mild Side Effects Of Hiv Treatment

When starting HIV treatment, there may be some milder side effects that can last a couple of weeks and then resolve as your body adjusts to the medication. You can manage these short-term side effects with a few self-care steps:

• Fatigue. Try to schedule extra rest, and if needed when fatigue sets in, temporarily scale back on strenuous workouts.
• Nausea. Eating smaller meals and limiting spicy foods may help. Try to avoid being around overpowering cooking aromas.
• Diarrhea. Be sure to drink plenty of water and other healthy beverages to replace lost fluids. Try cutting back on raw foods and whole grains as well as spicy dishes. Focus on bland food until you feel better.
• Rash. Skip scented body products and try to wear only natural, soft fibers like cotton and linen.

Other temporary side effects may include headache, fever, muscle pain, and dizziness. Ask your doctor if over-the-counter pain relievers are safe to take to help relieve these minor side effects.

However, be aware that sometimes side effects that seem mild like a rash, fever, or nausea may be a sign of a more serious medical problem that needs treatment. When starting a new HIV medication, be sure to ask your doctor how long you should wait for mild side effects to subside before seeking medical attention.

Also note that any allergic reaction to your medications like swelling on your face or around the eyes, lips, or tongue may be life-threatening and require immediate medical attention.

Activation Of The Chemoreceptor Trigger Zone

The chemoreceptor trigger zone is located in the highly vascular area postrema on the floor of the fourth ventricle and is not protected by the blood-brain barrier. It is activated by emetogenic chemicals in the bloodstream or cerebrospinal fluid as well as the stomach and small intestines via vagal afferents . Activation of the vomiting center via the CTZ is a common cause of NV, whether directly from emetogenic chemicals in the cerebrospinal fluids or bloodstream, or by vagal afferents ascending from the viscera that connect with the CTZ in the fourth ventricle.

The CTZ also responds to bloodborne stimuli such as apomorphine, digoxin, anesthetic agents, alcohol, opioids and chemotherapeutic agents . Receptors in the GI tract that activate the vagal afferents respond to chemical stimuli such as toxins, chemotherapeutic agents, acid, amino acids, fatty acids, and neurotransmitters. Some medications, perhaps as a result of local GI irritation or damage, can cause cells of the GI tract to release dopamine or serotonin, which in turn activate the vagus nerve . Gastroparesis may also play a role in NV in HIV . Gastroparesis can be a primary cause or secondary due to hypothyroidism, diabetes mellitus or visceral neuropathy .

The emetic response: Pathways, stimuli, and receptors

From Lehne, L. A., Moore, D. B., Crosby, R. A., & Hamilton, L. J. . Pathways, stimuli, and receptors . Pharmacology for nursing care, 3rded. Philadelphia: W. B. Saunders. Used with permission.

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Effects Of Probiotics On Diarrhea And Cd4 Cell Count In People Living With Hiv: A Systematic Review And Meta

• 1NHC Key Laboratory of Drug Addiction Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Medical University, Kunming, China
• 2Scientific Research Laboratory Center, First Affiliated Hospital of Kunming Medical University, Kunming, China
• 3Yunnan Institute of Digestive Disease, First Affiliated Hospital of Kunming Medical University, Kunming, China

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 infection bloody stool or watery, non-bloody.
• Cryptosporidiosis watery stool or bloody stool.
• Isosporiasis watery stool.
• Mycobacterium avium intracellulare infection -watery stool.
• Salmonella bloody stool, initially watery.

Other causes of acute diarrhea in immunocompetent persons may result in chronic diarrhea in HIV/AIDS patients.

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Cortical And Sensory Mechanisms

Psychogenic stimuli involve higher centers of the brain that activate the vomiting center directly. Traumatic experiences and terror can induce vomiting through stimulation of the cortex and in turn the vomiting center . Anticipatory vomiting involves activation of the cortex from a learned or conditioned response to certain stimuli for example, the patient receiving chemotherapy or the patient anticipating swallowing a large number of pills can stimulate the vomiting center . Other sensory inputs which can stimulate the vomiting center include visual, olfactory, gustatory, and pain .

When Might Diarrhea Occur And How Long Does It Last

For people with HIV, diarrhea can be caused by multiple factors. Each case should be reviewed individually, as causes can vary depending on:

• symptoms
• family history
• exposure to illness

Antiretroviral treatment can reduce the impact of the virus on the body, but diarrhea can also be a side effect of some medications.

Protease inhibitors are an important medication for treating HIV, but they may cause gastrointestinal distress. More recently introduced PIs, however, appear to be better tolerated. These include Prezista, Prezcobix, Reyataz, or Evotaz.

Other types of therapy for HIV can also cause gastrointestinal distress.

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Initiation Of Antiretroviral Therapy

Antiretroviral drug treatment guidelines have changed over time. Before 1987, no antiretroviral drugs were available and treatment consisted of treating complications from opportunistic infections and malignancies. After antiretroviral medications were introduced, most clinicians agreed that HIV positive patients with low CD4 counts should be treated, but no consensus formed as to whether to treat patients with high CD4 counts.

In April 1995, Merck and the National Institute of Allergy and Infectious Diseases began recruiting patients for a trial examining the effects of a three drug combination of the protease inhibitor indinavir and two nucleoside analogs. illustrating the substantial benefit of combining 2 NRTIs with a new class of antiretrovirals, protease inhibitors, namely indinavir. Later that year David Ho became an advocate of this “hit hard, hit early” approach with aggressive treatment with multiple antiretrovirals early in the course of the infection. Later reviews in the late 90s and early 2000s noted that this approach of “hit hard, hit early” ran significant risks of increasing side effects and development of multidrug resistance, and this approach was largely abandoned. The only consensus was on treating patients with advanced immunosuppression . Treatment with antiretrovirals was expensive at the time, ranging from $10,000 to $15,000 a year.

Treatment as prevention

Nitazoxanide For The Treatment Of Chronic Diarrhea In Hiv Infected Children

• Study Details

Cryptosporidium parvum is a parasite that can cause chronic diarrhea and is a significant problem for HIV infected children in developing countries. C. parvum infection can be treated with the drug nitazoxanide . However, NTZ has not been tested in HIV infected children. The purpose of this study is to test the safety of NTZ in HIV infected children who have chronic diarrhea caused by C. parvum.

Study hypothesis: Twice-daily NTZ is safe and well tolerated in HIV infected infants, children, and adolescents with chronic diarrhea caused by C. parvum infection.

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