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Diarrhea for a Year
Jul 29, 1999
I am an HIV positive male, have a CD4 count of about 4 and a Viral Load of 160,000. I have had (sudden onset) diarrhea since July 13, 1998 (when I was staying in a hotel in London, England last summer) and I have been off all anti-HIV medication for the past two months. I have tried all currently available HIV medication and am resistent to all currently available anti-HIV drugs. My weight in July of 1998 was 125lbs and now it is 95lbs (I have been as low as 88lbs about 2 months ago). I am 6 feet tall. I have tried several antibiotics to try to combat the diarrhea including erythromycin, claritromycin, floxin, azithromycin (which also served as MAC prophylasix). I have provided numerous stool samples (at least 7 samples), all of which came back negative. I also have Crohn's Disease (please note that if I take predisone, it worsens the diarrhea) and have had several colonoscopies in the past, one under general anesthetic. However, I have great hestitation in going under general again since I also have Hepatitis C and I am worried about the impact of it on my liver (moreover, my GI specialist is also very hesitant to do a colonoscopy due to my generally very fragile state of health). What is your opinion as to undergoing a colonoscopy under general anethetic (I do not want to have it done without general since I have experienced an extremely high degree of pain due to the inflammation caused by the Crohn's)? Also and more importantly, aside from a colonoscopy, what other procedures/scopes would you recommend and would you recommend I try any other antibiotics (since I have nothing to loose by trying them) or any other medication? My patience is waring thin since it has been a full year of diarrhea with no answers. Finally, what would you suggest regarding my diet (my appetite fluxuates but it is generally quite poor and I have tried most of the supplements available)?
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Response from Dr. Fisher
Is the diarrhea due to Crohn's? If so there is specific treatment for Crohn's which is unrelated to anything we might try for HIV-related diarrhea. I don't think the use of antibiotics is wise...you do have something to lose and that is that antibiotics can make you worse if given inappropriately.
Colonoscopy under general is not a high risk procedure...you never know when one of these tests might give an answer.
I'm not sure what to recommend about your diet...do you have a dietician available?
Alvan Fisher, M.D.
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