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Evaluation of the HIV-infected patient with diarrhea

C Mel Wilcox, MD
Christine A Wanke, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Jennifer Mitty, MD, MPH


Diarrhea can cause significant morbidity in HIV-infected patients and can be due to a multitude of etiologies from infectious pathogens to malignancy to medications. Diarrhea is also an independent predictor of reduced quality of life [1].

The approach to the evaluation of chronic diarrhea will be discussed here. For detailed information about specific pathogens, please see appropriate topic reviews. (See "AIDS-related cytomegalovirus gastrointestinal disease" and "Mycobacterium avium complex (MAC) infections in HIV-infected patients".)


Prior to the use of highly active antiretroviral therapy (HAART) in the United States, chronic diarrhea (defined as 28 days of diarrhea) was responsible for 17 percent of the new acquired immunodeficiency syndrome (AIDS) diagnoses reported to the Centers for Disease Control and Prevention (CDC) [2].

In the developing world, HAART is not routinely available for HIV-infected individuals, and diarrheal disease remains highly endemic even for those without HIV [3]. Chronic diarrheal disease in adults in Africa has been used as a predictor of HIV-seropositivity [4]. HIV-infected children are more likely to die with diarrhea than children with diarrhea who are not infected with HIV [5].

In contrast, in resource-rich nations where HAART is widely available, the incidence of infectious causes of diarrhea in HIV-infected patients with low CD4 counts (<200 cells/microL) has declined [6]. Experience at a single center between 1995 and 1997 found that, while the incidence of diarrhea remained constant, infectious etiologies declined from 53 to 13 percent [7].


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