HIV diarrhea
Background
- Chronic diarrhea (over 28 days), can be presenting symptom of AIDS, or in countries without HAART
- Less common after introduction of HAART
Clinical Presentation
- Ascertain whether small bowel vs large bowel diarrhea
- Small Bowel
- Diarrhea watery and copius
- Weight loss
- Bloating, gas, cramping
- Vit B12 deficient if terminal illeum involved
- Large Bowel
- Frequent small volume, possibly painful stools
- Hematochezia - Consider opportunistic pathogens, also consider classic hemorrhagic bacteria (e. coli O157, campylobacter, shigella, salmonella, Yersinia)
- Small Bowel
Differential Diagnosis
CD4>400
- Consider routine pathogens causing Diarrhea
- Side effect of nelfinavir and ritonavir
- Cryptosporidium parvum (brief course of illness) - severe watery diarrhea
CD4<200
- M. tuberculosis
- Histoplasma
- Cryptococcus
- Lymphoma
- Kaposi
- Enteroaggregative Escherichia coli (EAEC) (can also affect immunocompetent children)
- HIV can directly infiltrate bowel wall leading to diarrhea
CD4 <100
- Cryptosporidium parvum (chronic course of illness)
- Mycobacterium avium complex (MAC) - infiltration of bowel assoc with malabsorption
- CMV
- Isospora
- Microsporidium
Diagnosis
Management
Disposition
See Also
References
UpToDate: "Evaluation of the HIV-infected patient with diarrhea"