title: Review article: the aetiology, investigation and management of diarrhoea in the HIV-positive patient.
abstract: BACKGROUND
  Diarrhoea is a common presentation throughout the course of HIV disease.
  
  
  OBJECTIVE
  To review the literature relating to aetiology, investigation and management of diarrhoea in the HIV-infected adult.
  
  
  METHODS
  The PubMed database was searched using major subject headings 'AIDS' or 'HIV' and 'diarrhoea' or 'intestinal parasite'. The search was limited to adults and to studies with >10 patients.
  
  
  RESULTS
  Diarrhoea affects 40-80% of HIV-infected adults untreated with antiretroviral therapy (ART). First-line investigation is by stool microbiology. Reported yield varies with geography and methodology. Molecular and immunological methods and special stains have improved diagnostic yield. Endoscopy is diagnostic in 30-70% of cases of pathogen-negative diarrhoea and evidence supports flexible sigmoidoscopy as a first line screening procedure (80-95% sensitive for CMV colitis), followed by colonoscopy and terminal ileoscopy. Radiology is useful to assess severity, distribution, complications and to diagnose HIV-related malignancies. Side effects and compliance with ART are important considerations in assessment. There is a good evidence base for many specific therapies, but optimal treatment of cryptosporidiosis is unclear and only limited data support symptomatic treatments.
  
  
  CONCLUSIONS
  The immunological response to HIV infection and Antiretroviral therapy remains incompletely understood. Antiretroviral therapy regimens need to be optimised to suppress HIV while minimising side effects. Effective agents for management of cryptosporidiosis are lacking. There is an urgent need for enhanced regional diagnostic facilities in countries with a high prevalence of HIV. The ongoing roll-out of Antiretroviral therapy in low-resource settings will continue to change the aetiology and management of this problem, necessitating ongoing surveillance and study.
authors.affiliation: Department of Gastroenterology, University of Liverpool, Liverpool, UK.
authors.forename: N A
authors.initials: NA
authors.lastname: Feasey
authors.forename: P
authors.initials: P
authors.lastname: Healey
authors.forename: M A
authors.initials: MA
authors.lastname: Gordon
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects; D003967:Diarrhea / Q000209:etiology* / Q000628:therapy; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans
chemical_list: D019380:Anti-HIV Agents