Systematic review of strategies to measure HIV-related diarrhea.
BACKGROUND
In the highly active antiretroviral therapy (HAART) era, HIV-related diarrhea remains common. There is no gold standard to measure diarrhea, making comparison across trials difficult. We conducted a systematic review to determine current research practice in measuring HIV-related diarrhea.


METHODS
MEDLINE was searched from 1980 to 2006 for clinical trials of treatment for HIV-related diarrhea. The following data were abstracted: type of trial, treatment studied, definition of diarrhea, and definition of improvement in diarrhea.


RESULTS
We reviewed 384 articles; 46 met our inclusion criteria. Forty-two trials were prospective: 25 were open-label and 17 were controlled trials. Antimicrobials were studied most often (15 trials): octreotide was studied in 10 trials, and HAART in 5. Presence of diarrhea was most often defined by duration (33 trials, 72%), stool frequency (29 trials, 63%), and/or stool form (23 trials, 50%); often, more than one parameter was used. Stool frequency was used most often to measure diarrhea improvement (28 trials, 61%). Only one trial used a measure validated for HIV-related diarrhea.


CONCLUSIONS
Investigators rely on non-validated and disparate measures of HIV-related diarrhea. An easy-to-use, well-accepted, and valid tool to measure HIV-related diarrhea would enhance research in this field.
Tinmouth
Jill
J
Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. jill.tinmouth@sunnybrook.ca
Kandel
Gabor
G
Tomlinson
George
G
Walmsley
Sharon
S
Steinhart
Hillary A
HA
Glazier
Richard
R
D003967:Diarrhea / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D016896:Treatment Outcome