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Diarrhea

What is diarrhea?
Diarrhea is an increase in the frequency, amount or water content of bowel movements. It is a frequent problem for people with HIV/AIDS (PHAs) and may be caused by several factors. If diarrhea continues for more than a few days, it can cause serious problems.

The most serious complication resulting from diarrhea is dehydration. When you have diarrhea, your body loses both water and important minerals necessary for normal functions (such as sodium and potassium). If diarrhea continues for more than a few weeks, it will cause poor absorption of many nutrients. This can lead to weight loss (wasting).

What causes diarrhea?

The most common causes of diarrhea in PHAs include:

• infections of the stomach or bowel
• inflammation of the bowel caused by HIV
• certain medications used to treat HIV or related conditions

Infections and diarrhea

Many germs -- bacteria, parasites, fungi or virus -- can cause infection that lead to diarrhea. Some common ones that affect PHAs include the following:

• parasites such as Cryptosporidium, Giardia and Entamoeba
• viruses such as CMV (cytomegalovirus)
• fungi such as yeast or Candida
• bacteria such as MAC (Mycobacterium avium complex) and Salmonella

There are treatments available for most of these infections. Because combination therapy used to treat HIV strengthens the immune system, PHAs who take this treatment are less likely to develop these infections.

Diarrhea caused by HIV disease
HIV affects the normal working of the stomach and bowels. As a result, the stomach and bowels cannot digest food and absorb nutrients properly. This often causes diarrhea.

Diarrhea caused by medications
Many anti-HIV medications can cause diarrhea as a side effect. The most common ones to do so are nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Fortovase) and the original formulation of ddI (Videx), though almost all of them can. Drugs used to treat complications of HIV, such as ganciclovir (Cytovene,Valcyte) and interferon alpha (Intron-A, Pegetron, Pegasys), can often cause diarrhea as well. Sometimes, taking antibiotics (such as Septra and Penicillin) can kill off the good bacteria in your gut and lead to an overgrowth of other germs, causing diarrhea.

In addition, people who are lactose intolerant and have problems digesting milk or dairy products may have diarrhea if they eat or drink milk or dairy products.

Diarrhea can also be triggered or worsened by increased emotional stress.

How can diarrhea be treated?

• Drink lots of fluids: With diarrhea, your body loses a large amount of water. Drink plenty of clear fluids to replace the loss.
• Change what you eat:

• Avoid: all dairy products; greasy, fried and fatty food; spicy food; caffeine (found in coffee, chocolate, tea and pop); apple juice; whole wheat bread; corn
• eat more: bananas; white rice; congee or noodles; cereal; boiled eggs; oatmeal; mashed potatoes; yams and squash; toasted white bread; crackers; yogurt

Nutritional supplements and complementary therapies:

• A high fibre diet or fibre supplements such as Metamucil can add bulk and reduce diarrhea.
• Peppermint, nutmeg and ginger are believed to help with digestive problems. Peppermint or ginger tea or ginger ale may be good sources of clear fluids.
• Acidophilus is a supplement that contains friendly bacteria. Some PHAs take supplements of friendly bacteria to help prevent diarrhea that can occur when antibiotics are used.
• Calcium supplements may be effective in reducing diarrhea caused by medications, such as nelfinavir (Viracept).

Medications: Different medications are used to treat different types of diarrhea.

• For diarrhea caused by some bacteria or parasites, you may need special antibiotics to kill these germs before the diarrhea can be brought under control (for example, Humatin can be used to treat diarrhea caused by the parasite Cryptosporidium).
• For other diarrhea, medication that slows down movement in the intestine may be effective. These can include over-the-counter or prescription drugs such as Imodium, Kaopectate, Pepto-Bismol and Lomotil.

If your diarrhea does not get better in a few days, or if there is also fever or blood in the stool, consult your doctor right away to test for common causes of diarrhea that can be treated.

How can I reduce my risk of getting diarrhea?
Many types of diarrhea can be prevented by changes in our behaviours or use of preventive treatments. Here are some helpful tips:

• pay attention to food safety and avoid uncooked meat or raw vegetables
• practice safer sex and use a barrier when you perform rimming (oral/anal sex)
• talk with your doctor to see if you should consider taking anti-HIV medications
• before starting any new prescription drugs, always tell your doctor and pharmacist about the medications you are currently taking, including over-the-counter drugs, herbs and supplements.