Key points
- Diarrhoea is common in people with HIV, particularly those with a low CD4 count.
- It can be a side-effect of some anti-HIV drugs, or have another cause, such as food poisoning.
- Diarrhoea that isn’t related to HIV medication will usually settle down after a few days.
- Your doctor can investigate the cause of diarrhoea and provide treatment.
Diarrhoea is when your poo (stool) is more watery than is normal for you. It can also make you need the toilet more often and more urgently. If you have diarrhoea, it’s common to also have stomach pains, bloating, nausea, vomiting, fever, and to lose your appetite.
Diarrhoea is common among people with HIV. It can be a side-effect of anti-HIV drugs, as well as some other medicines, such as antibiotics.
Diarrhoea can also be caused by infections. If you have a weak immune system you may be more likely to get these infections and for them to be serious. HIV itself can also cause diarrhoea because of its effect on the gut.
Drug-related diarrhoea
Diarrhoea can be a side-effect of most anti-HIV drugs. In most cases, diarrhoea goes away after the first few weeks or months of treatment. However, for some people the problem carries on until they change their HIV treatment.
How bad diarrhoea is varies. Some drugs can cause severe diarrhoea, involving several trips to the toilet each day, with large, uncontrollable, liquid bowel movements, as well as feeling weak and dizzy. However, most of the anti-HIV drugs that cause this sort of serious diarrhoea are no longer used in the UK.
You can find out more about anti-HIV drugs and their possible side-effects in aidsmap’s drugs chart.
It’s important that you continue to eat and drink when you have diarrhoea. Unlike diarrhoea caused by other things, changing your diet probably won’t have much effect on drug-related diarrhoea, so just try to eat as normally as you can.
Do not stop taking your HIV medication because it causes diarrhoea.
Medical causes of diarrhoea
Diarrhoea is more common among people with HIV, particularly if you have a low CD4 count. This is because the HIV virus can damage your gut.
Causes of diarrhoea include:
- digestive problems, such as irritable bowel syndrome (IBS)
- medical problems such as appendicitis, food poisoning, or a food allergy or intolerance
- lifestyle factors, such as drinking a lot of alcohol or feeling anxious
- bacterial infections, parasites, and viruses.
Usually, diarrhoea with a medical cause will settle down after a few days.
Eat solid food as soon as you feel well enough. It is best to eat small, light meals.
Some foods can help make your poo firmer and less watery. These include:
- potatoes (without their skin)
- rice, pasta, crackers, and white bread
- bananas
- chicken, beef, and fish
- scrambled eggs.
Potassium is an important mineral that helps your body balance its fluids. Your levels of potassium often drop if you have severe diarrhoea. Good sources of potassium include bananas, fish, beef, and chicken.
For general advice on nutrition, read aidsmap’s page on healthy eating.
If your diarrhoea is caused by irritable bowel syndrome, changing the fibre content, and the type of fibre in your diet may help. There is more detailed advice on what you can do to reduce the symptoms of IBS, including diarrhoea, on the NHS website.
Getting treatment
A variety of treatments are available to try to control diarrhoea, such as Imodium (loperamide). This can be bought over the counter from chemists.
It’s a good idea to tell the chemist you are taking anti-HIV medication, especially if you are taking ritonavir (Norvir).
Diarrhoea can also cause soreness around your bottom (anus). Over-the-counter remedies for piles may soothe any discomfort.
If you have blood or mucus in your poo (stool), or if you have a high temperature, do not take over-the-counter medications. Speak to a healthcare professional instead.
It’s also important to speak to a healthcare professional if you have diarrhoea for more than a few days, or if over-the-counter medicines haven’t been working for you. They can run tests and work out the best treatment option. For example, they might be able to prescribe stronger anti-diarrhoea medication.
Your doctor may change your HIV treatment if they think it’s the cause of your diarrhoea.
If you have long-term (chronic) diarrhoea, you might find it helpful to speak to a specialist HIV dietitian. They can provide you with advice on any diet changes you should make, how to avoid losing weight, and how to get enough nutrients.
Staying hydrated
Diarrhoea can cause you to lose salts and water from your body, so it’s important to drink plenty of fluids to avoid dehydration.
It is best to drink fluids with a mix of water, salt, and sugar. You can buy rehydration drinks at chemists, or drink broth or a sports drink.
You will know if you are drinking enough by looking at the colour of your urine(pee). It should be light gold or almost clear in colour. Passing very little urine, or having very dark urine, can be a symptom of dehydration. You may also have a headache and feel dizzy.