I have unfortunately had diarrhea for a year now (though I've only been on meds for 2 months so I'm pretty sure its not them). Im on Sustiva + Kivexa which saw my VL drop from 500 000 to 260 in just 2 weeks. My CD4 (taken before meds) was 270.

I had a colonoscopy which showed I had 'intestinal spirochetes' for which I took metronidazole. The symptoms improved moderately but within a month they were back. I've not had a further colonoscopy but Im taking metronidazole again though I'm concerned that if they do not work again (8 days into a 10 day course and not much improvement) that I may be left with this problem indefinately.

I have kept diaries of what I'm eating and tried eliminating food types over the past year, I've tried marshmallow root and peppermint to help with the feeling of irritation in my lower bowel, I take loperamide on a daily basis (2mg) but nothing seems to make an awful lot of difference. Being a gay man I kind of need things to work down there if you know what I mean! I havent been able to be intimate with anyone for months.

I've been checked for parasites, STI's, etc and everything has come back clear.

Is it possible that just HIV alone can be a cause of intestinal problems? Is there anything else I can try short of just upping my daily dose of loperamide? Are there implications of taking loperamide on a long-term basis?

Many thanks, I hope you can help..

Looking for food sensitivities such as lactose or gluten intolerance is sometimes useful in the setting of chronic loose stools. Trying to normalize gut flora with active yogurt cultures can be helpful in some patients (again-need to check for lactose intolerance). HIV can cause a range of gut problems in some patients but often those will diminish with effective treatment. KH