Diarrhea in HIV

Aka: Diarrhea in HIV, HIV related Diarrhea, AIDS Associated Diarrhea

1. Epidemiology
   1. Diarrhea is most common intestinal HIV manifestation
   2. Affects 50-90% of HIV patients
2. Signs
   1. Often voluminous Secretory Diarrhea
3. Causes: Infectious (Pathogen identified in 85% of AIDS patient)
   1. Cryptosporidium
   2. Microsporidia
   3. Isospora belli
   4. Mycobacterium Avium Complex (MAC)
   5. Salmonella
   6. Campylobacter jejuni
   7. Cytomegalovirus (CMV) Infection
      1. Fever accompanies Diarrhea
   8. Herpes Simplex Virus (HSV)
      1. Can also cause rectal ulcers and pain
   9. Shigella
   10. Clostridium difficile
   11. Histoplasma capsulatum
4. Causes: Pathogen negative
   1. Gastrointestinal Cancer
      1. Non-hodgkin Lymphoma
      2. Kaposi Sarcoma
      3. Anal Squamous Cell Carcinoma
   2. Fat malabsorption (related to pancreatic exocrine insufficiency)
   3. Sexually Transmitted Disease with secondary Proctitis or anorectal ulcers
   4. Protease Inhibitor related adverse effects
   5. HIV-induced Diarrhea (HIV-Induced Enteropathy or AIDS Enteropathy)
      1. Can be chronic and cause severe wasting
      2. More common when CD4 Count <200/mm3
      3. Considered a diagnosis of exclusion
      4. Unclear etiology
         1. Possibly due to focal mucosal immune defects
         2. Secondary to CD4 Cell Count depletion
         3. Leads to Bacterial overgrowth
            1. Leads to Mucosal inflammation
5. Diagnosis
   1. Examine multiple stools first
   2. Stool exam not diagnostic
      1. Upper and lower endoscopy with biopsies and cultures