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Diarrhoea
Diarrhoea is common amongst people with HIV. It can be caused by some anti-HIV drugs and some medicines used to treat some other infections. In people with a low CD4 count diarrhoea may be directly caused by some opportunistic infections.
Diarrhoea can take the form of a semi-loose to completely liquid stool, and may result in having to go to the toilet more frequently and urgently. It is common for diarrhoea to be accompanied by stomach pains, bloating, nausea, vomiting, fever and loss of appetite.
Diarrhoea as a drug related side-effect
Diarrhoea has been reported as a side-effect of all the protease inhibitors as well as ddI (Videx) and abacavir (Ziagen) in the NRTI class, and with some antibiotics.
With some drugs, diarrhoea goes away after the first few weeks or months of treatment, however for some people it becomes a permanent feature of living with the drug.
The severity of the diarrhoea also varies. Severe diarrhoea, involving many trips to the toilet each day, large, uncontrollable liquid bowel movements, and feelings of weakness and dizziness as a result of the loss of fluids and salts is experienced by about a quarter of people starting treatment with nelfinavir (Viracept) and a fifth of people starting saquinavir (Invirase). Similar levels have been reported in people taking fosamprenavir (Telzir), lopinavir/ritonavir (Kaletra), ritonavir (Norvir) and indinavir (Crixivan). Less serious problems may be experienced by many other people taking protease inhibitors. However, many people find that after a few weeks or months on the drug the diarrhoea improves or becomes more manageable.
Changes in diet have little effect on protease inhibitor and other drug-related diarrhoea. However a variety of treatments are available from doctors to try and control diarrhoea caused by drugs.
These include:
- Imodium (loperamide). This is available on prescription from your doctor or can be bought over-the-counter from chemists. Stronger anti-diarrhoea drugs, such as lomotilor octreotide can be prescribed by your doctor.
- In some people, calcium supplements of 500mg twice a day have been shown to reduce the diarrhoea associated with nelfinavir
- Oat bran tablets have also been shown to be effective against nelfinavir-related diarrhoea. They work by absorbing fluid, making stools larger and slowing the movement of stools through the intestines.
Medical causes
Diarrhoea is very common amongst people with HIV, particularly those with a low CD4 count. Often no specific cause can be found, and in cases of mild diarrhoea it can often be attributed to the direct effect of HIV. Another common cause is irritable bowel syndrome, when diarrhoea often alternates with constipation and is associated with bloating and wind. Rather than being caused by an infection it is likely that lifestyle issues, such as stress are to blame.
In people with advanced HIV disease, infections such as cryptosporidium, clostridium difficile, microsporidium, CMV, MAI, giardia, salmonella and shigella can cause very serious diarrhoea.
What to do
Usually diarrhoea will settle down after a few days. Try and avoid coffee, raw vegetables and spicy food as they can make diarrhoea worse. If it persists it is important to see your doctor.
As diarrhoea may result in excessive loss of salts and water from the body it is important to drink plenty of fluids or special rehydration drinks. Eating foods like bananas, potatoes, chicken and fish will help you replace potassium, levels of which are commonly depleted in people with severe diarrhoea. Soluble fibre from natural sources like pulses, oats, bananas, apples and pears have also been shown to be effective against diarrhoea.
In many cases avoiding foods that are high in fat, fibre or lactose may help alleviate the symptoms of diarrhoea.
If you are losing weight because of diarrhoea it is important to speak to a dietitian as soon as possible who will work with you to develop a diet which is more appetising, or easy to absorb.
Increasing or decreasing the fibre content of your diet may help if you have irritable bowel syndrome, as might anti-spasmodic therapies such as Colofac.
Diarrhoea can also cause soreness around the anus. Over-the-counter remedies for piles may prove soothing.