Management of noninfectious diarrhea associated with HIV and highly active antiretroviral therapy.
In geographic locations where highly active antiretroviral therapy (HAART) is widely available, the nature of HIV-related diarrhea has shifted from being predominantly a consequence of opportunistic infection to being largely a side effect of HAART agents. With this shift has come a smaller risk for the life-threatening wasting and weight loss, although serious instances of noninfectious diarrhea remain a concern. While estimates vary, in part due to the lack of a standard diarrhea definition, over a quarter of patients receiving HAART experience diarrhea. The negative effect on quality-of-life in patients with HAART-related diarrhea is profound; diarrhea may also increase the risk of poor adherence to treatment, with potentially serious effects on viral suppression and increased risk of drug resistance. Diagnosis of HAART-related diarrhea largely involves ruling out pathogen involvement, which, in addition to laboratory testing, may require endoscopic examination. Treatment was, until recently, mainly supportive in nature. The recent US Food and Drug Administration approval of crofelemer offers the first reliably effective treatment for HAART-related diarrhea.
WSU Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 4B, Detroit, MI. E-mail: macarthur@wayne.edu.
Rodger D
RD
Macarthur
D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000930:Antidiarrheals / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D017326:Clinical Trials, Phase III as Topic; D003967:Diarrhea / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy*; D019468:Disease Management; D017277:Drug Approval; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D044945:Proanthocyanidins / Q000627:therapeutic use; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration
D019380:Anti-HIV Agents; D000930:Antidiarrheals; D044945:Proanthocyanidins; C546704:crofelemer