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Diarrhoea
Diarrhoea is common amongst people with HIV. It can be caused by some anti-HIV drugs, medicines used to treat some infections, and in people with a low CD4 count diarrhoea may be 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 and abacavir 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 several 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 electrolytes is experienced by about a quarter of people starting treatment with nelfinavir and a fifth of people starting saquinavir. Similar levels have been reported in people taking amprenavir, lopinavir, ritonavir and indinavir. Less serious problems may be experienced by many other people taking protease inhibitors.
Changes in diet have little effect on protease inhibitor and other drug-related diarrhoea. However a variety of treatments are available to 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 can be prescribed by your doctor.
- 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.
It is important that you continue to eat and drink even if you have diarrhoea which is caused by your medication. You should not stop taking your medication because it causes diarrhoea. You should discuss any problems with your doctor, who may be able to recommend treatments for the diarrhoea or, if necessary a change to a different anti-HIV drug regimen.
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, microsporidium, CMV, MAI, giardia, salmonella and shigella can cause very serious diarrhoea.
What to do
Usually diarrhoea will settle down after a few days. 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 fibres from natural sources like pulses, oats, bananas, apples and pears have also been shown to be effective against diarrhoea. Charcoal tablets may also be helpful.
Try and avoid coffee, raw vegetables and spicy food as they can make diarrhoea worse, and may also be triggers for nausea, which is often combined with diarrhoea. In many cases avoiding foods which are high in fat, or lactose may help alleviate the symptoms of diarrhoea.
Increasing or decreasing the fiber content of your diet may help if you have irritable bowel syndrome, as might anti-spasmodic therapies such as Colofac.
You might find it useful to speak to a specialist HIV dietician, who can provide you with advice on suitable dietary changes and how to avoid losing weight and how to get adequate nutrition when you have diarrhoea.
Diarrhoea can also cause soreness around the anus. Over the counter remedies for piles may prove soothing.