Diarrhea

Diarrhea is having loose, watery stools more than three times in one day. It happens more often in people with HIV. A person having diarrhea can lose a lot of water and nutrients the body needs. If the diarrhea isn’t brought under control, it can lead to wasting.

Diarrhea can be a serious problem for HIV-infected people. They may have to stay near a bathroom because of the unpredictability of diarrhea. Sometimes, a person with diarrhea may fear eating. This can weaken the immune system more and cause infections and depression. Some people don’t follow their program of highly active antiretroviral therapy (HAART) because they believe the medicines cause the diarrhea.

Symptoms

Along with the loose stools, there may be stomach cramping, bloating, nausea or an urgent need to use the bathroom. Depending on the cause, a person may have a fever or bloody stools.

One of the dangers of diarrhea is dehydration. This means that the body doesn’t have enough water. The signs of dehydration are generally:

• Thirst
• Less frequent urination
• Dry skin
• Fatigue
• Light-headedness
• Dark colored urine 

Causes

Diarrhea can be caused by many things, including:

• Antibiotics that kill off the good bacteria in the gut.
• Antiretroviral drugs, such as nelfinavir (Viracept®), ritonavir (Norvir®), Kaletra® (lopinavir plus ritonavir), ddI (Videx®), foscarnet (Foscavir®), tipranavir (Aptivus®) and interferon alfa (Roferon® or Intron®). Protease inhibitors are particularly likely to cause diarrhea.
• Bacteria, which are sometime found in contaminated food or water.
• Bowel disorders, in which the intestines do not work normally.  Some people get diarrhea after stomach surgery or removal of the gallbladder.
• Food intolerances. Some people can’t digest some foods, such as the lactose (a sugar) found in milk.
• Intestinal diseases, like inflammatory bowel disease or celiac disease.
• Pancreas problems
• Parasites, such as cryptosporidium or microsporidium. These problems don’t happen as often because of combination antiretroviral therapy.
• Reaction to medicines, such as antibiotics, blood pressure medications, and antacids containing magnesium.
• Stress
• Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.

Sometimes it isn’t possible to find out what is causing the diarrhea. It can still be treated without a known cause

Prevention

Sound tips to follow to help avoid diarrhea include:

• Washing your hands often, but especially before you eat
• Applying good food safety practices. Keep hot foods hot and cold foods cold. Make sure food is fresh.
• Avoid contaminated water by drinking bottled, boiled or filtered water.
• Avoid foods the body reacts to badly. Milk, caffeine-containing drinks, high fat or fried foods, alcohol and high levels of vitamin C can all lead to diarrhea.
• Taking care when traveling to avoid contaminated food and drinks 

Diagnosis

Diarrhea usually isn’t harmful. It can become serious or may be a sign of a more serious problem. A person should see a doctor right away if he or she has:

• A fever of 102º F or higher
• Bad pain in the belly or rectum
• Blood in the stool or stools that look black and tarry
• Diarrhea for more than three days
• Signs of dehydration

A doctor will ask about a person’s recent eating habits and the medicines or herbs he or she is taking. A physical examination will be done. If more information is needed, these tests may also be done:  

• A stool culture to check for bacteria, parasites, signs of disease or infection or signs that the body isn’t handling fat well
• Blood tests to rule out certain diseases
• Food allergy or intolerance tests. A doctor may ask you to avoid certain foods for a time to see if the diarrhea goes away.
• Tests that use special scopes to see inside the rectum or colon. These include a sigmoidoscopy or a colonoscopy.
• A CD4 cell count. This will show how strong the immune system is. When the CD4 cell count falls below 200, the risk of getting an infection goes up. 

Treatment

It is useful to know what is causing the diarrhea. Even if a cause can’t be found, the condition can be treated. Treating diarrhea focuses on stopping the diarrhea itself and treating possible dehydration.

Dehydration can be dangerous. With diarrhea, a person can lose up to a gallon of water a day. With the water, a person loses minerals (electrolytes) that are important for the body to work. The main minerals are sodium and potassium. If dehydration isn’t taken care of, the body can go into shock and possibly die.

To avoid dehydration, drink plenty of clear liquids. These include noncaffeinated teas, chicken broth, vegetable broth, ginger ale or soda. Plain water replaces fluids, but not electrolytes.

To stop the diarrhea, these may be helpful:

• Calcium, if antiretroviral drugs cause the diarrhea. Studies have shown that taking calcium can help relieve diarrhea in people taking nelfinavir (Viracept). Either calcium carbonate or calcium citrate will work. A prescription isn’t needed to buy calcium.
• Over-the-counter medicines like Pepto-Bismol®, Kaopectate® and Imodium AD®. (Do not take these medicines if bacteria or a parasite causes the diarrhea. If it is, these medications will make the diarrhea last longer.)
• Antibiotics to fight bacteria or parasites.
• Products that add bulk to the stool with soluble fiber. Examples include Metamucil®, Citrucel® or other products that contain psyllium. Oat bran also adds bulk to the stool.
• Changing the diet to avoid foods that contain dairy, fatty or spicy ingredients. Cutting back on raw fruits and vegetables, some grains and seeds.
• Eating bananas, plain white rice, applesauce, plain noodles, boiled eggs, mashed potatoes or oatmeal may help.