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Treatment of HIV-Related Diarrhea

Summary & Participants

Diarrhea in people with HIV may be caused by the disease itself, complications of the disease, or a side effect of treatment. Experts describe the range of therapies available to control this potentially life-threatening condition.

Medically Reviewed On: July 01, 2008

Webcast Transcript

ANNOUNCER: For HIV patients in the United States, treatments have advanced so much in recent years that diarrhea is seldom the life-threatening danger it used to be. When diarrhea does strike a patient with HIV today, many effective therapies are available, including medicines ranging from over-the-counter products, to hormonal therapy. When people with HIV experience diarrhea, it is often the result of the drugs that are helping keep the disease in check.

EDWARD S. GOLDBERG, MD: Diarrhea that you see now in people with AIDS usually is related to the treatment and not to the disease itself. So we have many drugs to treat AIDS, close to 20 now, and many of the side effects of those drugs cause diarrhea.

ANNOUNCER: Drugs used to fight HIV are usually combined in a regimen called Highly Active Anti-Retroviral Therapy, or "Haart." Drugs in one category of these medications are especially likely to cause diarrhea in some people.

BRIAN A. BOYLE, MD: They may end up with diarrhea from, for example, a protease inhibitor, which are probably the worst drugs to cause that.

ANNOUNCERS: Often doctors can effectively treat the side effect. Other times, they can swap protease inhibitors, or switch to an HIV therapy that avoids that class of drug altogether. Diarrhea is often much more serious when people with HIV begin to succumb to AIDS, often marked by a drop in a patient's disease-fighting T-cells.

BRIAN A. BOYLE, MD: They can still get bacterial infections that cause diarrhea. They can still get medication-induced diarrheas. But now there's a huge variety of other pathogens that especially in somebody who has very low T cells may cause problems. Viral pathogens, bacterial pathogens, atypical bacteria pathogens, parasites... all may cause diarrhea in these patients. And it may be profound and severe.

ANNOUNCER: HIV can also cause diarrhea directly.

EDWARD S. GOLDBERG, MD: The virus itself, it effects the immune system obviously. And the GI tract is like one big long immune system. When people have AIDS-related diarrhea, that's not caused by an opportunistic infection, it's because the virus is within the tissue of the GI tract which then disallows the GI tract to do its job. So it can't absorb nutrients. It can't absorb water. And that's a result directly from the virus.

ANNOUNCER: When therapies fail, when diagnosis comes late, or when a patient declines to undergo anti-retroviral therapy, diarrhea can be very severe.

BRIAN BOYLE, MD: Severe enough to be life threatening. I mean, people die from malabsorption, and people die from wasting, and people die from diarrhea, as they lose fluid, as well as lose nutrients. So it can be a significant factor in not only the health of the patient but also their survival.

ANNOUNCER: Doctors often treat diarrhea with drugs that slow the movement of the bowel, such as loperamide and diphenoxylate. Or they try bulking agents that absorb excess fluid. The next line of attack is sometimes hormonal therapy.

EDWARD S. GOLDBERG, MD: Well, the era of AIDS changes with each year and not long ago was an era where people actually died from AIDS-related diarrhea. When somatostatin became available, and we understood that it could be used to treat AIDS-related diarrhea, I feel that it definitely saved many people's lives by allowing them to stick around for the better treatments that became available -- say in 1996 and a little beyond that.

ANNOUNCER: Around the world, millions of people with HIV and AIDS suffer from severe diarrhea. In the United States, and other affluent countries, access to the latest HIV treatments mean fewer patients develop full-blown AIDS.

And with fewer complications like severe diarrhea, people with HIV are not only living longer, they are living with a much better quality of life.

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